BCBS KS Diagnosis and Treatment of Sacroiliac Joint Pain

BCBS KS Diagnosis and Treatment of Sacroiliac Joint Pain

by abilling, August 18, 2014

27096    Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed

BCBS of Kansas has updated its policy, limiting how they will pay for SI injections.

BCBS of KS POLICY reads:

A. Injection into the sacroiliac joint for diagnostic or therapeutic purposes may be considered medically necessary when all of the following conditions are met:

  1. Pain originates from the sacroiliac joint; and
  2. Duration of pain of at least 3 months; and
  3. Average pain level of ≥ 6 on a scale of 1 to 10; and
  4. Failure to respond to more conservative management including physical therapy and non-steroidal anti-inflammatory agents; and
  5. Lack of obvious evidence for disc related or facet joint pain
  6. The injections are performed under radiographic guidance

Repeat Injections:

  1. Repeat injections are to be no more frequent than every 2 months
  2. Repeat injections extending beyond 12 months may be reviewed for continued medical necessity


B. Sacroiliac injection is considered experimental / investigational for all other indications.

C. Arthrography of the sacroiliac joint is considered experimental / investigational.

D. Radiofrequency ablation of the sacroiliac joint is considered experimental / investigational.

E. Fusion / stabilization of the sacroiliac joint for the treatment of back pain presumed to originate from the SI joint is considered experimental / investigational, including but not limited to percutaneous and minimally invasive techniques.


ICD-9 Diagnoses


720.2 Sacroiliitis, not elsewhere classified 724.3 Sciatica
724.00 Spinal stenosis, unspecified region other than cervical 724.4 Thoracic or lumbosacral neuritis or radiculitis, unspecified
724.01 Spinal stenosis of thoracic region 724.5 Unspecified backache
724.02 Spinal stenosis of lumbar region, without neurogenic claudication 724.6 Disorders of sacrum
724.03 Spinal stenosis of lumbar region, with neurogenic claudication 724.70 Unspecified disorder of coccyx
724.09 Spinal stenosis, other region other than cervical 724.71 Hypermobility of coccyx
724.1 Pain in thoracic spine 724.79 Other disorder of coccyx
724.2 Lumbago 724.8 Other symptoms referable to back
724.9 Other unspecified back disorders


CMS has a broader list of covered diagnosis codes.  Basically the only ones acceptable to both are in bold print.



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abinsights readers are invited to submit comments, questions, tips, and suggestions for articles on any subject related to billing, collections, coding, reimbursement, and compliance.  Send to:  Anesthesia Billing, Inc.,     P O Box 388, Newton, KS  67114-0388.  Phone 316-281-3700.  Fax 316-282-4322.

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Reasonable attempts have been made to be accurate.  However, medical billing, collections, coding and compliance are part science, part art, and even experts sometimes differ.  Neither Anesthesia Billing, Inc., the editors, publisher, contributors, or consultants warrant or guarantee the information contained will be applicable or appropriate in all situations.  For information specific to your practice, consult a qualified professional.

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Editor:  Philip Blann (pblann@anesthesiabilling.com).

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