CPT G0260 · SI Joint Injection · Excellus BCBS
SI Joint Injection (Medicare ASC HCPCS) at Excellus BCBS.
How Excellus BCBS approaches CPT G0260 (SI Joint Injection (Medicare ASC HCPCS)) for prior-authorization review: at last review on 2026-04-27, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-04-27
Policy number
7.01.93 (referenced)Criteria summary
High-level themes from the Excellus BCBS policy of record for CPT G0260. 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.
See the full Excellus BCBS criteria.
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