CPT 27096 · SI Joint · Ambetter
Sacroiliac Joint Injection (CPT) at Ambetter.
How Ambetter approaches CPT 27096 (Sacroiliac Joint Injection (CPT)) for prior-authorization review: at last review on 2025-07-01, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2025-07-01
Policy number
CP.MP.166Criteria summary
High-level themes from the Ambetter policy of record for CPT 27096. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 4 weeks of conservative care typically required.
Source: Ambetter Centene CP.MP.166: Sacroiliac Joint Interventions for Pain Management
See the full Ambetter criteria.
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