Does 27278 require prior authorization?

Yes, 27278 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for 27278?

Medicare facility rate: $439.22. Non-facility rate: $13754.82. Work RVU: 7.66.

HCPCS/CPT

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Work RVU

7.66

Facility

$439.22

Non-Facility

$13754.82

The patient's medical record must contain documentation that fully supports medical necessity for services included within LCD L39810, including relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures.
Medical record documentation must be available to Medicare upon request.
Documentation of one diagnostic SIJ block with ≥75% pain reduction per L39402 (procedure note/results and pain scores).
Documentation of at least one therapeutic intra‑articular SIJ corticosteroid injection showing ≥50% pain reduction for the expected duration (procedure note/results and pain scores).

Coverage for minimally invasive arthrodesis of the sacroiliac joint (SIJ) is determined by the Local Coverage Determination L39810; follow the clinical indications and medical necessity criteria in LCD L39810.
Minimally invasive (MI) arthrodesis of the sacroiliac joint (SIJ) with placement of a transfixation device is covered when all other listed criteria are met.
At least one diagnostic SIJ block demonstrating ≥75% reduction in pain (per the definitions/requirements in policy L39402).
A trial of at least one therapeutic intra‑articular SIJ corticosteroid injection that produced ≥50% reduction in pain for the expected duration of the injected agent.
Imaging of the SIJ (plain radiographs and CT or MRI) documenting absence of destructive lesions (tumor, infection), fracture, traumatic SIJ instability, or inflammatory arthropathy that would make percutaneous SIJ fusion inappropriate.
AP pelvis plain radiograph to exclude concomitant hip pathology prior to MI SIJ arthrodesis.

CGS-L39802 — Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ)

J18 MAC Part B

NORIDIAN-L39810 — Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ)

JF Part B

PALMETTO-L39797 — Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ)

JJ Part B

A59695 — Billing and Coding: Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ)

Ask Verity about documentation requirements, denial risks, or coverage in your state.