Billing and Coding: Sacroiliac Joint Injections and Procedures

Medicare covers diagnostic and therapeutic sacroiliac joint injections when reasonable and necessary per LCD L39464, with diagnostic injections limited to two sessions and therapeutic injections limited to four sessions per rolling 12 months. Coding and billing rules vary by setting: professional services may use modifier 50 for bilateral procedures, ASC/OPPS facilities must bill HCPCS G0260 (with documented CT/fluoroscopic guidance) and cannot bill CPT 27096, CPT 64451 includes imaging guidance so separate imaging codes should not be billed, and non–FDA-approved biological injectants may result in claim denial.

"Diagnostic sacroiliac joint injections (SIJI) are covered when reasonable and necessary per LCD L39464 and may be performed unilateral or bilateral."

Sign up to see full coverage criteria, indications, and limitations.