CPT G0260 · SI Joint · Horizon BCBS NJ
SI Joint Injection (Medicare ASC HCPCS) at Horizon BCBS NJ.
How Horizon BCBS NJ approaches CPT G0260 (SI Joint Injection (Medicare ASC HCPCS)) for prior-authorization review: at last review on 2026-05-10, the policy covers this code with prior authorization required.
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139Verification pending. This record is awaiting confirmation against the latest policy document — criteria summary may not reflect the current revision.
Criteria summary
High-level themes from the Horizon BCBS NJ 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.
Source: Horizon BCBSNJ - SI Joint Injection (Policy 139 framework)
See the full Horizon BCBS NJ criteria.
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