Does 27096 require prior authorization?

No, 27096 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 27096?

Medicare facility rate: $73.82. Non-facility rate: $175.69. Work RVU: 1.44.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

1.44

Facility

$73.82

Non-Facility

$175.69

The medical record must be legible, with every page containing appropriate patient identification (e.g., full name, dates of service).
The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
Submitted medical records must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
The procedural report must clearly document the indication and medical necessity for the block(s) and record pre- and immediate post-injection percent (%) pain relief achieved.

Diagnostic sacroiliac joint injection(s) (CPT 27096 and/or 64451) to confirm sacroiliac joint–mediated pain; may be performed unilateral or bilateral.
Therapeutic sacroiliac joint injection(s) (CPT 27096 and/or 64451) for treatment of sacroiliac joint pain; may be performed unilateral or bilateral.
Injections of the nerves innervating the sacroiliac joint should be performed/reported with CPT 64451 (includes imaging guidance).
Diagnostic sacroiliac joint injections (CPT 27096 and/or 64451) are covered when used to diagnose sacroiliac joint–mediated pain and are reasonable and necessary per LCD L39475.
Therapeutic sacroiliac joint injections (CPT 27096 and/or 64451) are covered when medically necessary for treatment of sacroiliac joint pain per LCD L39475.
Injections of the nerves innervating the sacroiliac joint should be reported and are covered with CPT 64451 (which includes imaging guidance).

L39475 — Sacroiliac Joint Injections and Procedures

J05

A59257 — Billing and Coding: Sacroiliac Joint Injections and Procedures

J05

L39455 — Sacroiliac Joint Injections and Procedures

J06

A59233 — Billing and Coding: Sacroiliac Joint Injections and Procedures

J06

CGS-L39383

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