CPT 27096 · SI Joint · Medicare (NGS MAC)
Sacroiliac Joint Injection (CPT) at Medicare (NGS MAC).
How Medicare (NGS MAC) approaches CPT 27096 (Sacroiliac Joint Injection (CPT)) for prior-authorization review: at last review on 2026-05-03, the policy covers this code without prior authorization.
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Coverage
Covered
Prior auth
No prior auth
Last reviewed
2026-05-03
Policy number
L39054Criteria summary
High-level themes from the Medicare (NGS MAC) 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.
- Prior Diagnostic SIJI with ≥ 75% relief documentation required (typically with ≥75% relief).
Source: LCD L39054 — Sacroiliac Joint Injections and Procedures (NGS)
See the full Medicare (NGS MAC) criteria.
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