Billing and Coding: Sacroiliac Joint Injections and Procedures

Medicare covers diagnostic and therapeutic sacroiliac joint injections (primarily CPT 27096 and CPT 64451) when reasonable and necessary per LCD L39475, with nerve injections billed as CPT 64451 which includes imaging. Utilization limits allow up to 2 diagnostic sessions and up to 4 therapeutic sessions per rolling 12 months; ASC/OPPS facilities should report G0260 with documented fluoroscopic/CT guidance while CPT 27096 is not recognized in ASC/OPPS, and non–FDA-approved biologic injectants are excluded and may cause claim denial.

"Diagnostic sacroiliac joint injections (CPT 27096 and/or 64451) are covered when used to diagnose sacroiliac joint–mediated pain and are reasonable and necessary per LCD L39475."

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