Billing code 27096: SI joint injectionMedicare rate & RVUs in Oregon
Reports an image-guided injection into the sacroiliac joint for diagnostic or therapeutic care when medication is delivered within the joint.
Medicare pays $173.81–$188.90 for 27096 in the office in Oregon, from Rest Of Oregon to Portland. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 27096 covers
This service places a needle into the sacroiliac joint under fluoroscopic or CT guidance, typically to deliver local anesthetic, corticosteroid, or contrast. Pain medicine physicians, anesthesiologists, physiatrists, and radiologists commonly perform it in office or facility settings for suspected or established sacroiliac joint pain. The injection is intra-articular; medication placed only in nearby muscles or soft tissue is a different service.
Report the code for the guided joint injection, including the imaging guidance and arthrography when performed; do not separately report guidance for this injection. The record should identify the treated side, target joint, imaging method, needle placement, and medication or contrast delivered. The procedure has a 0-day global period, so same-day preoperative and postoperative care is included. For bilateral treatment, modifier 50 is paid at 150%. When performed with other procedures in the same session, the highest-valued procedure is paid in full and other procedures are subject to the standard 50% multiple-procedure reduction. Medicare does not pay an assistant at surgery; co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 27096 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $188.90 | $75.72 |
| Rest Of Oregon | $173.81 | $72.34 |
How the 27096 rate is calculated
Each of 27096’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 27096
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.44Practice expense 3.68Malpractice 0.14
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 27096
The CMS indicators that decide how 27096 is paid alongside other services.
CMS payment indicators · 27096
SI joint injection
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 2 | Standard reduction: highest-valued procedure at 100%, others at 50%. |
| Bilateral (modifier 50) | 1 | Bilateral with modifier 50 pays 150% of the fee schedule amount. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 50 · payment effect
With and without the modifier
27096 without 50 · national office
$175.69
SI joint injection
27096-50 · Bilateral: 150%
$263.54
Both sides on one line with modifier 50 are paid at 150% of the fee schedule amount (subject to multiple-procedure rules with other procedures).
27096 compared with similar codes
Compare codes
27096 vs 20552 vs 64451 vs 20610: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 20552Trigger point injection
- 27096 is for an image-guided intra-articular SI joint injection. 20552 is for trigger-point injections into one or two muscles, not an image-guided joint injection.
- 64451SI nerve block
- 64451 addresses nerves supplying the SI joint; 27096 delivers medication into the joint space itself.
- 20610Joint injection
- 20610 applies to aspiration or injection of a major joint or bursa, such as the hip or knee. 27096 specifically describes an image-guided SI joint injection.
27096 billing questions
When should 27096 be chosen over 20552?
Use 27096 for an image-guided injection into the sacroiliac joint itself. Code 20552 describes trigger-point injections into one or two muscles, including situations where an SI-region injection is performed without image guidance.
Can imaging guidance be billed separately?
No. Fluoroscopic or CT guidance is included in 27096, as is arthrography when performed.
How is bilateral SI joint injection reported?
Report modifier 50 when both sacroiliac joints are treated. CMS pays the bilateral procedure at 150%.
What documentation supports 27096?
Document the clinical indication, side and joint treated, imaging method and needle placement, and the medication or contrast injected. The record should support that the needle entered the joint rather than only nearby soft tissue.
Can an assistant or co-surgeon be reported?
Medicare does not pay an assistant at surgery for this code. Co-surgeon and team-surgery reporting are not permitted.
What happens when another procedure is performed in the same session?
The highest-valued procedure is paid in full, and the other procedure or procedures are subject to the standard 50% multiple-procedure reduction.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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