CPT G0260 · SI Joint · Horizon NJ Health — NJ Medicaid
SI Joint Injection (Medicare ASC HCPCS) at Horizon NJ Health — NJ Medicaid.
How Horizon NJ Health — NJ Medicaid approaches CPT G0260 (SI Joint Injection (Medicare ASC HCPCS)) for prior-authorization review: at last review on 2026-05-06, the policy covers this code with prior authorization required.
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SI-InjCriteria summary
High-level themes from the Horizon NJ Health — NJ Medicaid 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 — G0260 SI joint injection (ASC facility code)
See the full Horizon NJ Health — NJ Medicaid criteria.
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