Sacroiliac Joint Injections and Procedures
J15 · Effective Mar 19, 2023
14 active Medicare policies list 64625, and 16 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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J15 · Effective Mar 19, 2023
J6 · Effective Mar 19, 2023
JK · Effective Mar 19, 2023
JE · Effective Mar 19, 2023
JF · Effective Mar 19, 2023
JJ · Effective Mar 19, 2023
JM · Effective Mar 19, 2023
J5 · Effective Mar 19, 2023
J8 · Effective Mar 19, 2023
16 policies from 15 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 64625 |
|---|---|---|
| Cigna Commercial Interventional Pain Management Code List | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 64625 |
|---|---|---|
| Back Pain - Invasive Procedures | Mar 13, 2024 | Covered |
| Policy | Effective | Status of 64625 |
|---|
National · Effective Mar 26, 2026
National · Effective Oct 18, 2024
J6 · Effective Apr 1, 2026
National · Effective Mar 5, 2026
J5 · Effective Dec 26, 2024
| Sacroiliac Joint Interventions for Pain Management | Not recorded | Covered |
|---|
| Policy | Effective | Status of 64625 |
|---|---|---|
| Facet Joint and Sacroiliac Joint Denervation | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 64625 |
|---|---|---|
| Facet Joint and Sacroiliac Joint Denervation | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 64625 |
|---|---|---|
| Facet Joint and Sacroiliac Joint Denervation | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 64625 |
|---|---|---|
| Facet Joint and Sacroiliac Joint Denervation | Jan 1, 2026 | Covered |
| Policy | Effective | Status of 64625 |
|---|---|---|
| Interventional Pain Management | Jun 14, 2026 | Covered |
| Policy | Effective | Status of 64625 |
|---|---|---|
| Cigna Medicare Advantage Interventional Pain Management Code List | Jan 1, 2025 | Prior auth required |
| Policy | Effective | Status of 64625 |
|---|---|---|
| EOCCO Pain Management Code List | May 1, 2026 | Prior auth required |
| Policy | Effective | Status of 64625 |
|---|---|---|
| Radiofrequency Ablation and Injection of Sacroiliac Joint Nerves | Oct 1, 2025 | Covered |
| Policy | Effective | Status of 64625 |
|---|---|---|
| Ablative Treatment for Spinal Pain – Surest Medical Policy | May 1, 2026 | Covered |
| Policy | Effective | Status of 64625 |
|---|---|---|
| Ablative Treatment for Spinal Pain | Feb 1, 2026 | Covered |
| Policy | Effective | Status of 64625 |
|---|---|---|
| Ablative Treatment for Spinal Pain | Feb 1, 2026 | Covered |
| Policy | Effective | Status of 64625 |
|---|---|---|
| Pain Management | Not recorded | Covered |