CPT G0260 · SI Joint · Independence Blue Cross
SI Joint Injection (Medicare ASC HCPCS) at Independence Blue Cross.
How Independence Blue Cross approaches CPT G0260 (SI Joint Injection (Medicare ASC HCPCS)) for prior-authorization review: at last review on 2025-06-11, the policy covers this code with prior authorization required.
Free with practitioner sign-in — magic-link email auth, no credit card.
11.15.23lCriteria summary
High-level themes from the Independence Blue Cross policy of record for CPT G0260. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 4 weeks of conservative care typically required.
- Imaging concordance documentation required.
- Prior Diagnostic SI block documentation required (typically with ≥75% relief).
Source: Independence Blue Cross Commercial 11.15.23l — SI Joint Injections (HCPCS G0260 listed in policy)
See the full Independence Blue Cross 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 →