Billing and Coding: Sacroiliac Joint Injections and Procedures

Medicare covers diagnostic and therapeutic sacroiliac joint injections (commonly billed with CPT 27096 and CPT 64451) performed unilaterally or bilaterally when medically necessary, with nerve injections reported as CPT 64451. Coverage limits include a maximum of 2 diagnostic sessions and 4 therapeutic sessions per rolling 12 months, specific billing rules by setting (ASC/OPPS/CAH/physician CMS‑1500), documentation requirements (signed records, procedural report with pre/post pain relief, imaging with ≥2 views), and prohibition/possible denial for non‑FDA approved injectants; HCPCS G0260 is required for ASC/OPPS instead of CPT 27096.

"Diagnostic sacroiliac joint injection(s) (CPT 27096 and/or CPT 64451) are covered when performed to evaluate/confirm sacroiliac joint–mediated pain."

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