CPT 64517 · SI Joint · UnitedHealthcare Community Plan (Medicaid)
Superior Hypogastric Plexus Block at UnitedHealthcare Community Plan (Medicaid).
How UnitedHealthcare Community Plan (Medicaid) approaches CPT 64517 (Superior Hypogastric Plexus Block) for prior-authorization review: at last review on 2026-05-06, the policy covers this code without prior authorization.
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Criteria summary
High-level themes from the UnitedHealthcare Community Plan (Medicaid) policy of record for CPT 64517. Verbatim policy text and per-criterion analysis are available after sign-in.
Coverage criteria details available after sign-in.
Source: UnitedHealthcare Community Plan Medicaid Coverage Policy — Sacroiliac Joint Injections
See the full UnitedHealthcare Community Plan (Medicaid) criteria.
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