g0260 CPT Code Reimbursement Explained

Sacroiliac (SI) joint injections are commonly used to help diagnose and treat low back and pelvic pain thought to originate from the SI joint. Proper coding is important for ensuring accurate billing and reimbursement for these procedures. This article will explore key details about g0260 CPT code for SI joint injections.

Key Takeaways

• G0260 is the CPT code used to report image-guided sacroiliac joint injections in the ASC and outpatient hospital setting.
• It includes both intra-articular and peri-articular injections.
• G0260 should be reported with an additional CPT code for the specific imaging modality used.
• Medicare reimburses g0260 at the ASC rate of approximately $260-270 depending on location.
• G0260 is considered bundled into 27096 (SI joint fusion) if both procedures are performed in the global period.
• Coding guidelines instruct providers to report g0260 for SI joint injections rather than 64483 or 64484.

When to Use G0260 CPT Code

G0260 is the proper CPT code for image-guided sacroiliac joint injections performed in ASC facilities and hospital outpatient departments. This code includes intra-articular injections directly into the SI joint space as well as peri-articular injections around the joint.

G0260 includes both the injection procedure as well as imaging guidance using fluoroscopy or CT scan. It should not be reported with 64483 (injection, anesthetic agent; lumbar or sacral (caudal)), 64484 (other peripheral nerve or branch), or 77003 (fluoroscopic guidance).

G0260 Billing and Reimbursement

Medicare reimburses g0260 CPT code at approximately $260-270 depending on geographic location. Private insurers typically reimburse close to Medicare rates.

Make sure to verify coverage policies as some insurers consider SI joint injections investigational for certain indications. Uninsured/self-pay patients may be charged $800 or more by some practices.

G0260 vs 27096 CPT Code

27096 describes sacroiliac joint arthrodesis, also known as SI joint fusion surgery. If 27096 and g0260 are performed in the global surgery period, g0260 is bundled into 27096 and should not be reported separately.

Outside of the global surgery period, g0260 may be reported if performing a diagnostic or therapeutic SI joint injection in a patient with a history of prior SI joint fusion.

Coding Guidelines for SI Joint Injections

Per CPT coding instructions, g0260 is the appropriate code for image-guided SI joint injections rather than 64483 or 64484. Some payers may still recognize 64483 for these injections, but g0260 is the most accurate code.

Make sure to report g0260 with a corresponding code for fluoroscopy (77002 or 77003) or CT guidance (77021) to specify the imaging used. Append modifier -50 if bilateral injections are performed.

Accurate coding is key to ensuring proper reimbursement and avoiding delays or denials. Following CPT guidelines helps convey the procedure performed and supporting imaging guidance. Consult your local Medicare contractor’s policies for any additional billing instructions.

FAQs about G0260

Is CPT code 27096 the same as G0260?

No, 27096 describes sacroiliac joint fusion surgery while g0260 reports sacroiliac joint injections.

Does Medicare pay G0260?

Yes, Medicare reimburses g0260 for sacroiliac joint injections in the ASC and outpatient hospital setting.

What is the CPT code for SI joint radiofrequency ablation?

64625 describes radiofrequency ablation of the SI joint.

What is the CPT code for SI joint fusion?

27096 is the CPT code for sacroiliac joint arthrodesis or fusion.

Accurate reporting of CPT code g0260 along with imaging guidance codes ensures proper reimbursement for SI joint injections. Pay close attention to payer policies and coding guidelines to avoid unnecessary claim denials.