Procedure billing guide

Sacroiliac (SI) Joint Procedure Billing and Coding

Sacroiliac joint injections are billed with CPT 27096, which requires and includes imaging guidance. Blocks of the nerves that supply the SI joint are 64451, radiofrequency ablation of those nerves is 64625, and minimally invasive SI joint fusion is 27279 or 27278 depending on the technique. Coverage for SI joint RFA varies widely by payer, so it should be checked before every case.

Updated October 12, 2026

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CPT codes

What are the CPT codes for sacroiliac joint procedures?

Code	Description
27096	Sacroiliac joint injection with imaging guidance (fluoroscopy or CT)
64451	Injection of nerves innervating the SI joint, with imaging
64625	Radiofrequency ablation of nerves innervating the SI joint, with imaging
27278	Percutaneous SI joint arthrodesis with intra-articular implant, without transfixation device
27279	Percutaneous or minimally invasive SI joint arthrodesis with transfixation device

Codes shown for reference. Always confirm against the current year’s CPT code set and your payer’s policy.

Billing rules

How do you bill SI joint procedures?

Are sacroiliac joint procedures covered by insurance?

It depends on the procedure. SI joint injections are widely covered when SI joint pain and failed conservative care are documented. SI joint RFA is considered experimental by many payers, and SI joint fusion usually needs prior authorization, imaging, positive diagnostic injections and months of failed conservative care.

SI joint injections (27096) are widely covered with documented SI joint pain and failed conservative care
SI joint RFA (64625) is considered experimental by many payers, so we verify coverage first
SI joint fusion usually requires prior authorization, imaging, positive diagnostic injections and months of failed conservative care

How do you code SI joint procedures correctly?

27096 requires and includes imaging guidance; an SI joint injection without imaging uses a different code. Bilateral SI joint injections take modifier 50, and minimally invasive SI joint fusion is coded 27279 when a transfixation device is used and 27278 when it is not.

27096 requires imaging guidance; without imaging, a different code applies
Use modifier 50 for bilateral SI joint injections
Choose between 27278 and 27279 based on whether a transfixation device is used

Common denials

Why are SI joint claims denied?

These are the denial reasons we see most often. We check for each one before a claim goes out, instead of finding out from a denial.

Denials we prevent

SI joint RFA billed to a payer that does not cover it
Fusion performed without documented diagnostic injections
Bilateral injection billed without modifier 50

FAQ

Sacroiliac Joint Procedures questions

What is the CPT code for a sacroiliac joint injection?

A sacroiliac joint injection with fluoroscopic or CT guidance is CPT 27096. Use modifier 50 when both sides are injected.

Is SI joint radiofrequency ablation covered by insurance?

Coverage for SI joint RFA (64625) varies. Many payers consider it experimental, so we check the payer's policy and obtain prior authorization or a signed patient waiver before the procedure.

Sources

Coverage rules change; always check the current version of each policy and your payer’s own rules.

Keep reading

Related services and procedures

Radiofrequency Ablation (Rhizotomy)

Facet, genicular and SI joint RFA coding, diagnostic block rules and repeat limits.

Facet Joint Injections

Facet injections and medial branch blocks: levels, modifiers and the Medicare facet LCD.

Prior Authorization

Approvals for injections, RFA, SCS and kyphoplasty, matched to each payer's criteria.

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