CPT G0260 · SI Joint · BCBS Tennessee
SI Joint Injection (Medicare ASC HCPCS) at BCBS Tennessee.
How BCBS Tennessee approaches CPT G0260 (SI Joint Injection (Medicare ASC HCPCS)) for prior-authorization review: at last review on 2026-04-09, the policy covers this code with prior authorization required.
Free with practitioner sign-in — magic-link email auth, no credit card.
Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-04-09
Policy number
BCBS-TN MPM (SI Joint Pain) ID_BACriteria summary
High-level themes from the BCBS Tennessee policy of record for CPT G0260. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 12 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: BCBS-TN Medical Policy — Diagnosis and Treatment of Sacroiliac Joint Pain
See the full BCBS Tennessee criteria.
Sign in for verbatim conservative-care language, exact imaging-concordance rules, repeat-procedure thresholds, and the denial-risk score for any specific clinical scenario.
Sign in — free for practitioners →