Billing and Coding: Sacroiliac Joint Injections and Procedures

Sacroiliac joint injections and sacral nerve blocks are covered when reasonable and necessary per LCD L39383, may be performed unilateral or bilateral, and must meet facility-specific coding rules (e.g., ASC/OPPS use HCPCS G0260; CPT 27096 is not recognized in ASC/OPPS). Documentation must include imaging guidance where required, procedural details, percent pain relief, and evidence of conservative management. Utilization limits: up to 2 diagnostic sessions and up to 4 therapeutic sessions per rolling 12 months; non–FDA-approved biological injectants are not covered and may cause claim denial.

"Sacroiliac joint injections (diagnostic or therapeutic) are covered when determined reasonable and necessary per the applicable Local Coverage Determination (LCD L39383)."

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