Injection · Hip

27096

Injection into the sacroiliac joint with fluoroscopic or CT image guidance, including arthrography when performed.

Verified May 8, 2026 · 5 sources ↓

Medicare
$175.69
Total RVUs
5.26
Global, days
0
Region
Hip
Drawn from CMSAAPCPriorityhealth

Documentation requirements

What must appear in the operative or office note to support the claim.

Source · Editorial brief grounded in 5 cited references ↓

  • Specify fluoroscopic or CT guidance was used — not ultrasound; ultrasound does not satisfy the code descriptor
  • Document clinical indication and medical necessity for the injection (diagnostic vs. therapeutic intent)
  • Record pre- and post-injection pain relief percentage immediately following the procedure
  • Note laterality (left, right, or bilateral) in the procedural report
  • For diagnostic injections, confirm this is within the first 1–2 sessions used to establish the diagnosis
  • Maintain hard-copy images or digital image documentation in the medical record for arthrography when performed

Applicable modifiers

Modifiers commonly billed with this code.

Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual

50 Bilateral procedure 59 Distinct service LT Left side RT Right side KX Documentation on file 52 Reduced services 76 Repeat, same physician 77 Repeat, another physician

What this code covers

Source · Editorial summary grounded in 5 cited references ↓

CPT 27096 covers a sacroiliac joint injection — anesthetic, steroid, or other therapeutic agent — performed under fluoroscopic or CT guidance. Image guidance is bundled into the base code; do not separately report 77003 or 77012. Arthrography, when performed as part of the procedure, is also included.

The code has a 000-day global period, meaning no post-procedure care is bundled. Diagnostic injections require the KX modifier, and CMS limits coverage to no more than 2 diagnostic sessions total (CPT 27096 and/or 64451, unilateral or bilateral) to confirm a diagnosis. Therapeutic injections are capped at 4 sessions per rolling 12 months across both codes, regardless of sidedness.

CPT 27096 is valid on professional claims across settings, but it is not recognized by OPPS or for ASC facility billing — those settings use G0260 instead. For bilateral injections on professional claims, append modifier 50. Do not report 27096 and 64451 for the same side in the same session.

RVU & reimbursement

Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.

Source · CMS Physician Fee Schedule, RVU26A · January 2026

Work RVU1.44
Practice expense RVU3.68
Malpractice RVU0.14
Total RVU5.26
Medicare national rate$175.69
Global period0 days

Payment by site of service

Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.

Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026

SettingMedicare rate (national)
Office (PFS non-facility)
Procedure performed in physician's office
$175.69

Common denial reasons

The recurring reasons claims for CPT 27096 get rejected.

Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓

  • Imaging guidance billed separately (77003 or 77012) when it is already bundled into 27096
  • 27096 submitted on ASC facility or OPPS claims where G0260 is the required code
  • KX modifier missing on diagnostic injection claims where payer requires it
  • Exceeding utilization limits — more than 2 diagnostic or 4 therapeutic sessions per 12 months (CPT 27096 and/or 64451 combined)
  • Modifier 50 incorrectly appended when 27096 and 64451 are performed on opposite sides (contralateral unilateral pair does not qualify for modifier 50)
  • 27096 and 64451 billed for the same side in the same session, which is not permitted per CMS policy

Frequently asked questions

Source · Generated from the editorial pipeline, verified against 5 cited references ↓

01Can I bill 77003 or 77012 alongside 27096 for the fluoroscopy or CT used during the injection?
No. Fluoroscopic and CT guidance are bundled into 27096. Separately reporting 77003 or 77012 triggers NCCI edits and automatic denial. The same rule applies regardless of whether the injecting physician or a radiologist interprets the images.
02What code do ASC facilities use instead of 27096?
ASC facilities and OPPS hospital outpatient departments bill G0260. CPT 27096 is not recognized under OPPS and is not a covered ASC facility service. Professional services performed in an ASC still use 27096 with standard modifier rules. Critical Access Hospitals (TOB 85X) use 27096.
03How do I bill bilateral sacroiliac joint injections on a professional claim?
Append modifier 50 to 27096 on a single line. For bilateral procedures in an ASC facility setting, bill two separate lines — one with modifier LT and one with modifier RT — and do not use modifier 50 on the facility claim.
04When should I use the KX modifier with 27096?
Append KX to every diagnostic injection line. KX is required only for diagnostic sessions, not therapeutic ones. CMS limits covered diagnostic sessions to no more than 2 (across 27096 and 64451 combined) to confirm a diagnosis. Repeat diagnostics beyond that threshold are not considered reasonable and necessary.
05Can I bill 27096 and 64451 together on the same claim?
Only if they are performed on opposite sides. Billing 27096 (SI joint injection) and 64451 (sacral nerve block) for the same side in the same session is not permitted per CMS policy. When performed contralaterally, do not append modifier 50 to either code — they are two distinct unilateral procedures.
06Can 27096 be performed with ultrasound guidance?
No. The code descriptor specifies fluoroscopy or CT guidance only. Using ultrasound and billing 27096 does not satisfy the code requirements and will not survive audit. If ultrasound is used, the procedure does not map to this code.
07How many therapeutic SI joint injections does Medicare cover per year?
CMS covers no more than 4 therapeutic sessions per rolling 12 months, counting both CPT 27096 and CPT 64451 combined, regardless of whether procedures are unilateral or bilateral. Claims beyond this threshold will be denied as not reasonable and necessary.

Sources & references

Editorial content was developed using the following public sources. Last verified May 8, 2026.

  1. 01
    cms.gov
    https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=59154&ver=12
  2. 02
    cms.gov
    https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=59192&ver=15
  3. 03
    aapc.com
    https://www.aapc.com/blog/3695-cpt-27096-requires-fluoroscopic-guidance/
  4. 04
    priorityhealth.stylelabs.cloud
    https://priorityhealth.stylelabs.cloud/api/public/content/a45eeb7a67ab4f0aa41aa0fd85e3a039?v=5def247e
  5. 05CMS Physician Fee Schedule 2026

Mira AI Scribe

Mira's AI scribe captures the image guidance modality (fluoroscopy vs. CT), injection laterality, agent(s) injected, whether arthrography was performed, and documented pre- and post-injection pain relief percentage from provider dictation. This prevents the two most common denial triggers: a missing or incorrect imaging notation that auditors use to question medical necessity, and laterality ambiguity that leads to incorrect modifier 50 application or same-side 27096/64451 conflicts.

See how Mira captures CPT 27096 documentation

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