Billing and Coding: Sacroiliac Joint Injections and Procedures

Medicare covers diagnostic and therapeutic sacroiliac joint injections (CPT 27096 and/or 64451) and sacral nerve injections (CPT 64451) when medically necessary, performed unilateral or bilateral, with imaging guidance included for CPT 64451 and HCPCS G0260 used for ASC/OPPS facility claims. Utilization limits: up to 2 diagnostic sessions total and up to 4 therapeutic sessions per rolling 12 months; KX modifier is required for initial diagnostic injections only. Non–FDA approved biological injectants are not allowed and inclusion may result in claim denial; thorough, signed, and legible documentation (including procedural indications, pre/post pain relief, and imaging confirming needle position) is required.

"Diagnostic sacroiliac joint injection(s) (CPT 27096 and/or 64451) to confirm sacroiliac joint–mediated pain; may be performed unilateral or bilateral."

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