Improved prior authorization process for sacroiliac joint injections
AI Summary
Beginning April 1, 2026, UnitedHealthcare will eliminate medical necessity reviews for sacroiliac joint injection prior authorizations (CPT 27096 and HCPCS G0260), but will still require prior authorization with site-of-service reviews. For Kentucky and North Carolina Community Plans, CPT 27096 will no longer require prior authorization at all.
Action Required
Before April 1, 2026: Billing team must update prior authorization workflows for CPT 27096 and HCPCS G0260 to remove medical necessity documentation requirements but maintain site-of-service reviews for UnitedHealthcare Commercial and Individual Exchange plans. For UnitedHealthcare Community Plans in Kentucky and North Carolina, remove all prior authorization requirements for CPT 27096. Update billing system flags and staff training materials accordingly.
Affected Billing Codes
Plan Types
Commercial, Exchange
Specialties
ortho, pain-management, pm-r