CPT G0260 · SI Joint · Molina Healthcare of Florida
SI Joint Injection (Medicare ASC HCPCS) at Molina Healthcare of Florida.
How Molina Healthcare of Florida 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.
Free with practitioner sign-in — magic-link email auth, no credit card.
Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-05-06
Policy number
Molina MCP-033Criteria summary
High-level themes from the Molina Healthcare of Florida 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 Molina Healthcare of Florida 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 →