Does G0260 require prior authorization?

Yes, G0260 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for G0260?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`G0260`, Injection procedure for sacroiliac joint; provision of anesthetic, steroid

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

The medical record must be legible, with every page containing appropriate patient identification (e.g., full name, dates of service).
The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
Submitted medical records must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
The procedural report must clearly document the indication and medical necessity for the block(s) and record pre- and immediate post-injection percent (%) pain relief achieved.
Retain films showing a minimum of two views documenting final needle position and contrast flow; make these available upon request.
Patient records should include the performing provider’s assessment related to the complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit or operative report.

Key Coverage Criteria

Diagnostic sacroiliac joint injection(s) (CPT 27096 and/or 64451) to confirm sacroiliac joint–mediated pain; may be performed unilateral or bilateral.
Therapeutic sacroiliac joint injection(s) (CPT 27096 and/or 64451) for treatment of sacroiliac joint pain; may be performed unilateral or bilateral.
Injections of the nerves innervating the sacroiliac joint should be performed/reported with CPT 64451 (includes imaging guidance).
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.
Therapeutic sacroiliac joint injections (CPT 27096 and/or 64451) are covered when medically necessary for treatment of sacroiliac joint pain per LCD L39475.
Injections of the nerves innervating the sacroiliac joint should be reported and are covered with CPT 64451 (which includes imaging guidance).

20 Active Policies

CGS-J15-L39383, Sacroiliac Joint Injections and Procedures

J15

CGS-J18-L39383, Sacroiliac Joint Injections and Procedures

J18

A59257, Billing and Coding: Sacroiliac Joint Injections and Procedures

WPS-J5-L39475, Sacroiliac Joint Injections and Procedures

A59233, Billing and Coding: Sacroiliac Joint Injections and Procedures

NGS-J6-L39455, Sacroiliac Joint Injections and Procedures

WPS-J8-L39475, Sacroiliac Joint Injections and Procedures

NORIDIAN-JE-L39462, Sacroiliac Joint Injections and Procedures

NORIDIAN-JF-L39462, Sacroiliac Joint Injections and Procedures

PALMETTO-JJ-L39402, Sacroiliac Joint Injections and Procedures

NGS-JK-L39455, Sacroiliac Joint Injections and Procedures

PALMETTO-JM-L39402, Sacroiliac Joint Injections and Procedures

BCBSMT-SUR705.043, Sacroiliac Joint Injections

BCBSNM-SUR705.043, Sacroiliac Joint Injections

BCBSOK-SUR705.043, Sacroiliac Joint Injections

CARELON-interventional-pain-management-2024-06-30-for-ohio-medicaid, Interventional Pain Management

CARELON-interventional-pain-management-2025-07-26-for-anthem-bc-ca-commercial, Interventional Pain Management

CARELON-interventional-pain-management-2026-06-14, Interventional Pain Management

EVICORE-HPLAN-AETNA-E6DAD43A2777, Aetna Interventional Pain Code List - Effective 01/01/2025

EVICORE-HPLAN-CIGNA-AFCE721BA4F3, Cigna Comprehensive Code List - Effective 03/07/2026

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about G0260 Sign up free

G0260, Injection procedure for sacroiliac joint; provision of anesthetic, steroid

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

The medical record must be legible, with every page containing appropriate patient identification (e.g., full name, dates of service).
The record must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
Submitted medical records must support the selected ICD-10-CM code(s) and the submitted CPT/HCPCS code must accurately describe the service performed.
The procedural report must clearly document the indication and medical necessity for the block(s) and record pre- and immediate post-injection percent (%) pain relief achieved.
Retain films showing a minimum of two views documenting final needle position and contrast flow; make these available upon request.
Patient records should include the performing provider’s assessment related to the complaint, relevant medical history, results of pertinent tests/procedures, and a signed and dated office visit or operative report.

Key Coverage Criteria

Diagnostic sacroiliac joint injection(s) (CPT 27096 and/or 64451) to confirm sacroiliac joint–mediated pain; may be performed unilateral or bilateral.
Therapeutic sacroiliac joint injection(s) (CPT 27096 and/or 64451) for treatment of sacroiliac joint pain; may be performed unilateral or bilateral.
Injections of the nerves innervating the sacroiliac joint should be performed/reported with CPT 64451 (includes imaging guidance).
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.
Therapeutic sacroiliac joint injections (CPT 27096 and/or 64451) are covered when medically necessary for treatment of sacroiliac joint pain per LCD L39475.
Injections of the nerves innervating the sacroiliac joint should be reported and are covered with CPT 64451 (which includes imaging guidance).

20 Active Policies

CGS-J15-L39383, Sacroiliac Joint Injections and Procedures

J15

CGS-J18-L39383, Sacroiliac Joint Injections and Procedures

J18

A59257, Billing and Coding: Sacroiliac Joint Injections and Procedures

WPS-J5-L39475, Sacroiliac Joint Injections and Procedures

A59233, Billing and Coding: Sacroiliac Joint Injections and Procedures

NGS-J6-L39455, Sacroiliac Joint Injections and Procedures

WPS-J8-L39475, Sacroiliac Joint Injections and Procedures

NORIDIAN-JE-L39462, Sacroiliac Joint Injections and Procedures

NORIDIAN-JF-L39462, Sacroiliac Joint Injections and Procedures

PALMETTO-JJ-L39402, Sacroiliac Joint Injections and Procedures

NGS-JK-L39455, Sacroiliac Joint Injections and Procedures

PALMETTO-JM-L39402, Sacroiliac Joint Injections and Procedures

BCBSMT-SUR705.043, Sacroiliac Joint Injections

BCBSNM-SUR705.043, Sacroiliac Joint Injections

BCBSOK-SUR705.043, Sacroiliac Joint Injections

CARELON-interventional-pain-management-2024-06-30-for-ohio-medicaid, Interventional Pain Management

CARELON-interventional-pain-management-2025-07-26-for-anthem-bc-ca-commercial, Interventional Pain Management

CARELON-interventional-pain-management-2026-06-14, Interventional Pain Management

EVICORE-HPLAN-AETNA-E6DAD43A2777, Aetna Interventional Pain Code List - Effective 01/01/2025

EVICORE-HPLAN-CIGNA-AFCE721BA4F3, Cigna Comprehensive Code List - Effective 03/07/2026

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about G0260 Sign up free

`G0260`, Injection procedure for sacroiliac joint; provision of anesthetic, steroid

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G0260`, Injection procedure for sacroiliac joint; provision of anesthetic, steroid

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G0260, Injection procedure for sacroiliac joint; provision of anesthetic, steroid

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

G0260, Injection procedure for sacroiliac joint; provision of anesthetic, steroid

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`G0260`, Injection procedure for sacroiliac joint; provision of anesthetic, steroid

`G0260`, Injection procedure for sacroiliac joint; provision of anesthetic, steroid