CPT 27096 · SI Joint · Wellpoint of New Jersey — NJ Medicaid
Sacroiliac Joint Injection (CPT) at Wellpoint of New Jersey — NJ Medicaid.
How Wellpoint of New Jersey — NJ Medicaid approaches CPT 27096 (Sacroiliac Joint Injection (CPT)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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Carelon IPM (MSK01)Criteria summary
High-level themes from the Wellpoint of New Jersey — NJ Medicaid policy of record for CPT 27096. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 6 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Carelon Clinical Appropriateness Guidelines — Interventional Pain Management
See the full Wellpoint of New Jersey — NJ Medicaid criteria.
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