Medicare (CMS LCD/NCD) LinQ Procedure (Posterior Sacroiliac Joint Fusion) prior authorization requirements (2026)
What Medicare (CMS LCD/NCD) generally requires to approve LinQ Procedure (Posterior Sacroiliac Joint Fusion) (CPT 27278), for Medicare (NC) plans. Based on the cited policy, Medicare (CMS LCD/NCD) does not generally require prior authorization for LinQ Procedure (Posterior Sacroiliac Joint Fusion) (CPT 27278). Confirm with Medicare (CMS LCD/NCD), as this can vary by plan.
Medical-necessity criteria Medicare (CMS LCD/NCD) generally applies
Palmetto GBA LCD L39797 - Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ) (revision effective 04/17/2025). "Coverage Indications, Limitations, and/or Medical Necessity" section, VERBATIM from the CMS Medicare Coverage Database API on 2026-09-20 (HTML converted to text; nothing paraphrased): Covered Indications Minimally Invasive (MI) Arthrodesis of the sacroiliac joint (SIJ) WITH placement of a transfixation device is considered medically reasonable and necessary when ALL of the following criteria are met: Patient must meet all requirements for coverage as outlined in Sacroiliac Joint Injections and Procedures L39402 including: At least 1 diagnostic block with >=75% reduction of pain as defined in L39402 AND A trial of at least 1 therapeutic intra-articular SIJ injection (i.e., corticosteroid injection that results in a >=50% reduction of pain for the expected duration of the injected agent AND Diagnostic imaging studies that include ALL the following: Imaging (plain radiographs and a computed tomography (CT) or magnetic resonance imaging (MRI)) of the SIJ that excludes the presence of destructive lesions (e.g., tumor, infection), fracture, traumatic SIJ instability, or inflammatory arthropathy that would not be properly addressed by percutaneous SIJ fusion (SIJF) Imaging of the pelvis (anteroposterior (AP) plain radiograph) to rule out concomitant hip pathology Imaging of the lumbar spine (CT or MRI) to rule out neural compression or other degenerative condition that can be causing low back or buttock pain B . MI Arthrodesis of the SIJ WITHOUT placement of a transfixation device is NOT considered medically reasonable and necessary. Limitations: Absence of generalized pain behavior (e.g., somatoform disorder) or generalized pain disorders (e.g., fibromyalgia) Patient should be part of an ongoing care plan, and be actively participating in a rehabilitation program, home exercise program or functional restoration program [NEEDS CLINICAL SPOT-CHECK]
How to submit
- Method: Traditional Medicare: no prior authorization in the office or ASC setting - bill Part B with documentation on file. If performed in a HOSPITAL OUTPATIENT DEPARTMENT, check the CMS OPD prior-authorization list for the specific code before the date of service. Medicare Advantage plans (Humana, UHC, Aetna, Blue Medicare) require their own PA but must apply this LCD's criteria under 42 CFR 422.101(b).
Sources & verification
- BindingSource - LCD: Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ) (L39797) · effective 2025-04-17.View
Binding = the payer's own policy. Proxy = a public, evidence-based clinical guideline the payer mirrors. Portal-only = the binding criteria are confirmed in the administrator's portal. Always confirm against the payer for the member's specific plan. Last verified 2026-09-20.
Frequently asked questions
Does Medicare (CMS LCD/NCD) require prior authorization for LinQ Procedure (Posterior Sacroiliac Joint Fusion)?
Based on the cited policy, Medicare (CMS LCD/NCD) does not generally require prior authorization for LinQ Procedure (Posterior Sacroiliac Joint Fusion) (CPT 27278). Confirm with Medicare (CMS LCD/NCD), as this can vary by plan.
What does Medicare (CMS LCD/NCD) require to approve LinQ Procedure (Posterior Sacroiliac Joint Fusion)?
Palmetto GBA LCD L39797 - Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ) (revision effective 04/17/2025). "Coverage Indications, Limitations, and/or Medical Necessity" section, VERBATIM from the CMS Medicare Coverage Database API on 2026-09-20 (HTML converted to text; nothing paraphrased): Covered Indications Minimally Invasive (MI) Arthrodesis of the sacroiliac joint (SIJ) WIT… Always confirm against the current Medicare (CMS LCD/NCD) policy.
How long does a Medicare (CMS LCD/NCD) prior authorization take?
Turnaround varies by plan and submission method. Check the Medicare (CMS LCD/NCD) portal for current timeframes.
Submitting LinQ Procedure (Posterior Sacroiliac Joint Fusion) to Medicare (CMS LCD/NCD)?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.