CPT 27096 · SI Joint · Independence Blue Cross
Sacroiliac Joint Injection (CPT) at Independence Blue Cross.
How Independence Blue Cross approaches CPT 27096 (Sacroiliac Joint Injection (CPT)) for prior-authorization review: at last review on 2025-06-11, the policy covers this code with prior authorization required.
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11.15.23lCriteria summary
High-level themes from the Independence Blue Cross 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.
- Imaging concordance documentation required.
- Prior Diagnostic SI block (intra-articular) documentation required (typically with ≥75% relief).
Source: Independence Blue Cross Commercial 11.15.23l — Sacroiliac Joint Injections
See the full Independence Blue Cross criteria.
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