G0260, Injection procedure for sacroiliac joint; provision of anesthetic, steroid
HCPCS/CPT
Prior Authorization
Prior Auth Required
Code explicitly requires prior authorization (high confidence)
Medicare Pricing
Documentation Required
- 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.
- Procedural reports must document indications, medical necessity, and the immediate pre- and post-injection percent (%) pain relief achieved.
- Retain and make available imaging films that document final needle position and contrast flow with a minimum of two views.
Key Coverage Criteria
- 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.
20 Active Policies
CGS-L39383, Sacroiliac Joint Injections and Procedures
J15
A59257, Billing and Coding: Sacroiliac Joint Injections and Procedures
J5
A59233, Billing and Coding: Sacroiliac Joint Injections and Procedures
J6
WPS-L39475, Sacroiliac Joint Injections and Procedures
J8
NORIDIAN-L39462, Sacroiliac Joint Injections and Procedures
JF
PALMETTO-JJ-L39402, Sacroiliac Joint Injections and Procedures
JJ
NGS-L39455, Sacroiliac Joint Injections and Procedures
JK
PALMETTO-JM-L39402, Sacroiliac Joint Injections and Procedures
JM
CARELON-interventional-pain-management-2024-01-01, Interventional Pain Management
CARELON-interventional-pain-management-2024-06-30-for-ohio-medicaid, Interventional Pain Management
CARELON-interventional-pain-management-2025-07-26, Interventional Pain Management
BCBSOK-SUR705.043, Sacroiliac Joint Injections
EVICORE-HPLAN-AETNA-E6DAD43A2777, Aetna Interventional Pain Code List - Effective 01/01/2025
EVICORE-HPLAN-CIGNA-1815296EE67F, Cigna Comprehensive Code List - Effective 03/07/2026
EVICORE-HPLAN-CIGNA-844835841DE9, Cigna Commercial Interventional Pain Management Code List - Effective 03/07/2026
EVICORE-HPLAN-HAP-AB9D421BCDBD, Health Alliance Plan MSK Code List - Effective 01/01/2026
A59154, Billing and Coding: Sacroiliac Joint Injections and Procedures
SUR705.043, Sacroiliac Joint Injections
A59192, Billing and Coding: Sacroiliac Joint Injections and Procedures
A59244, Billing and Coding: Sacroiliac Joint Injections and Procedures
Related Codes
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