CommercialPrior AuthMedium impact
Improved prior authorization process for sacroiliac joint injections
UnitedHealthcare·Orthopedics, Pain Management, PM&R (Physical Medicine & Rehab)·Prior authorization
Effective date
Apr 1, 2026
We identified it
Jun 13, 2026
Summary
Beginning April 1, 2026, UnitedHealthcare will remove medical necessity reviews from prior authorization requirements for sacroiliac joint injections (CPT 27096 and HCPCS G0260), but will still require prior authorization with site-of-service reviews. For UnitedHealthcare Community Plans in Kentucky and North Carolina, prior authorization will be completely eliminated for CPT 27096.
Action Required
By April 1, 2026: Billing team must update prior authorization workflows for sacroiliac joint injections to remove medical necessity documentation requirements while maintaining site-of-service verification for CPT 27096 and HCPCS G0260. For UnitedHealthcare Community Plans in Kentucky and North Carolina only, completely remove prior authorization requirements for CPT 27096. Update billing system rules and staff training accordingly.