CommercialPrior AuthMedium impact
Improved prior authorization process for sacroiliac joint injections
UnitedHealthcare·Orthopedics, Pain Management, PM&R (Physical Medicine & Rehab)·Prior authorization updates
Effective date
Apr 1, 2026
We identified it
Jan 12, 2026
Summary
Starting April 1, 2026, UnitedHealthcare will remove medical necessity reviews from prior authorization requirements for sacroiliac joint injections (G0260 and CPT 27096), but will still require prior authorization with site-of-service reviews. UnitedHealthcare Community Plans in Kentucky and North Carolina will no longer require prior authorization for CPT 27096 at all.
Action Required
By April 1, 2026: Billing team must update prior authorization workflows for sacroiliac joint injections to remove medical necessity review requirements while maintaining site-of-service reviews for both G0260 and 27096. For UnitedHealthcare Community Plans in Kentucky and North Carolina, remove prior authorization requirements entirely for CPT 27096. Update billing system rules and staff training accordingly.