Does 64625 require prior authorization?

No, 64625 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 64625?

Medicare facility rate: $176.69. Non-facility rate: $495.67. Work RVU: 3.31.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

3.31

Facility

$176.69

Non-Facility

$495.67

The medical record must document that fluoroscopic or CT guidance was used when reporting HCPCS G0260.
All records must be legible, include patient identification and dates of service, and contain the legible signature of the physician or non-physician practitioner responsible for care.
The submitted medical record must support the selected ICD-10-CM code(s) and the CPT/HCPCS code must accurately describe the service performed.
Maximum conservative management must be documented, including medical management and documented reasons if conservative measures were not optimized.

Sacroiliac joint injections (diagnostic or therapeutic) are covered when determined reasonable and necessary per the applicable Local Coverage Determination (LCD L39383).
Injections of the nerves innervating the sacroiliac joint (sacral nerve blocks) are covered and should be reported with CPT 64451 when reasonable and necessary.
Sacroiliac joint injections may be performed unilateral or bilateral in the same session and are allowable when medically indicated.
Diagnostic sacroiliac joint injections (SIJI) and sacral nerve blocks (initial diagnostic injections) are covered and should be billed with the KX modifier for the initial diagnostic injection(s).
Therapeutic SIJI or sacral nerve block procedures (unilateral or bilateral) are covered when medically necessary and billed using CPT 27096 and/or 64451 as appropriate.
For ASC facility (specialty 49) and OPPS hospital outpatient department facility claims, use HCPCS G0260 for SIJI facility billing and document fluoroscopic or CT guidance in the medical record.

A59257 — Billing and Coding: Sacroiliac Joint Injections and Procedures

J05

L39475 — Sacroiliac Joint Injections and Procedures

J05

A59233 — Billing and Coding: Sacroiliac Joint Injections and Procedures

J06

L39455 — Sacroiliac Joint Injections and Procedures

J06

A59246

Ask Verity about documentation requirements, denial risks, or coverage in your state.