Cigna prior authorization for 27198*: Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/inferior rami, unilateral or bilateral; with manipulation, requiring more than local anesthesia (ie, general anesthesia, moderate sedation, spinal/epidural)
Code
27198*
Description
Closed treatment of posterior pelvic ring fracture(s), dislocation(s),
diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum,
with or without anterior pelvic ring fracture(s) and/or dislocation(s) of
the pubic symphysis and/or superior/inferior rami, unilateral or bilateral;
with manipulation, requiring more than local anesthesia (ie, general
anesthesia, moderate sedation, spinal/epidural)
Source
Master Precertification List
For Health Care Providers, Pg 28 Original policy
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