Rubrica

CPT G0260 · SI Joint · UnitedHealthcare Community Plan (Medicaid)

SI Joint Injection (Medicare ASC HCPCS) at UnitedHealthcare Community Plan (Medicaid).

How UnitedHealthcare Community Plan (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 without prior authorization.

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Coverage Covered
Prior auth No prior auth
Last reviewed 2026-05-06

Criteria summary

High-level themes from the UnitedHealthcare Community Plan (Medicaid) policy of record for CPT G0260. Verbatim policy text and per-criterion analysis are available after sign-in.

Coverage criteria details available after sign-in.

Source: UnitedHealthcare Community Plan Medicaid Coverage Policy — Sacroiliac Joint Injections

See the full UnitedHealthcare Community Plan (Medicaid) criteria.

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