SIJ facility fee?

[bedrock]

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I’d like to hear everyone’s thoughts on whether or not SIJ injections pay a facility fee in the ASC?

This didn’t matter for my first jobs which were office based.
My business office manager has told me twice that SIJ injections don’t pay an ASC facility fee. Someone else’s business manager recently said that SIJ injections DO pay a facility fee.

I’m hoping for clarification

 

[DOctorJay]

G0260 (27096) Sacroiliac joint, arthrography $315.83 $322.32 $328.95 $358.74$371.753.6%

https://asipp.org/wp-content/uploads/2025Final_ASC.pdf

I'm thinking it does based on the ASIPP document above, await real world experience from those with ASCs

 

[BobBarker]

It pays very, very little for most insurances.

 

[bedrock]

It pays very, very little for most insurances.

What does it pay for Medicare ?

(And if you happen to know for BCBS, but I understand that is state dependent)

I’m trying to figure out if ASCs lose money on Medicare and or BCBS SIJ injections

 

[callmeanesthesia]

It would appear the hospital bills a G code?

Procedure Price Lookup for Outpatient Services | Medicare.gov

Use official Procedure Price Lookup tool to compare national average to Medicare costs in ambulatory surgical centers, hosptial outpatient departments

www.medicare.gov

 

[bedrock]

G0260 (27096) Sacroiliac joint, arthrography $315.83 $322.32 $328.95 $358.74$371.753.6%

https://asipp.org/wp-content/uploads/2025Final_ASC.pdf

I'm thinking it does based on the ASIPP document above, await real world experience from those with ASCs

Thank you

Two things.
1-can you please send me ASIPP 2025 for office based procedures?

2- my understanding is that the office procedure code for SIJ is 27096.

Is the G0260 code just for ASC/hospital facility charges?
Are both 27096 and G0260 billed if a physician performs an SIJ in a facility?

 

[DOctorJay]

Thank you

Two things.
1-can you please send me ASIPP 2025 for office based procedures?

2- my understanding is that the office procedure code for SIJ is 27096.

Is the G0260 code just for ASC/hospital facility charges?
Are both 27096 and G0260 billed if a physician performs an SIJ in a facility?

All of it is here

Fee Schedules - American Society of Interventional Pain Physicians

2026 Fee Schedules 2026 Proposed Physician Fee Schedule | IPM Codes2026 Final ASC Fee Schedule | IPM Codes 2025 Fee Schedules 2025 Final Physician Fee Schedule | IPM Codes2025 Final ASC Fee Schedule | […]

asipp.org

 

[Ducttape]

the physician can only bill the 27096 code.

the ASC bills the G0260 code.

from the CMS document, the payment for G0260 is $371.75. 2025 data.

you can find this on the CMS website here:

License Agreement | CMS

www.cms.gov

open the pdf july_2025_asc_addenda.2025.06.30

then click open the excel document 508-Version-Jul-2025-ASC-AA_2025.06.30

then scroll down to line 4195.

 

[PMROralBoards]

All of it is here

Fee Schedules - American Society of Interventional Pain Physicians

2026 Fee Schedules 2026 Proposed Physician Fee Schedule | IPM Codes2026 Final ASC Fee Schedule | IPM Codes 2025 Fee Schedules 2025 Final Physician Fee Schedule | IPM Codes2025 Final ASC Fee Schedule | […]

asipp.org

Didn’t realize how much we are getting screwed next year until looking at that

 

[bedrock]

All of it is here

Fee Schedules - American Society of Interventional Pain Physicians

2026 Fee Schedules 2026 Proposed Physician Fee Schedule | IPM Codes2026 Final ASC Fee Schedule | IPM Codes 2025 Fee Schedules 2025 Final Physician Fee Schedule | IPM Codes2025 Final ASC Fee Schedule | […]

asipp.org

thanks. I didn't realized ASIPP was allowing access again for non members. I've been using 2023 as a reference for a while!

 

[bedrock]

Didn’t realize how much we are getting screwed next year until looking at that

Very frustrating. I'm going follow SSDOC advice and have all mbb come back for a quick visit and bill a level 4 to regain what they are stealing from me.

 

[SSdoc33]

Very frustrating. I'm going follow SSDOC advice and have all mbb come back for a quick visit and bill a level 4 to regain what they are stealing from me.

great. now just never do a caudal and become a bleeding heart. you have seen the light.....

honestly, i used to feel bad about bringing in patients for this nonsense. but now IDGAF. it is typically just an insurance copayment and the patient's time we are wasting. these are INSURANCE REGULATIONS. all blame should always be placed on the big bad insurance company.

i still feel a bit icky charging for disability paperwork/FMLA. that comes directly out of the patient's pocket and there is almost never a big bank account attached to it. plus, i hardly ever actually write what the patient wants, so i dont want to charge for it.

 

[hopefulraddaddypls]

I’d like to hear everyone’s thoughts on whether or not SIJ injections pay a facility fee in the ASC?

This didn’t matter for my first jobs which were office based.
My business office manager has told me twice that SIJ injections don’t pay an ASC facility fee. Someone else’s business manager recently said that SIJ injections DO pay a facility fee.

I’m hoping for clarification

Nice car

 

[BoardingDoc]

Didn’t realize how much we are getting screwed next year until looking at that

Yeah, WTF happened to the sheet that was floating around a while ago that showed an increase of almost 10%? Now everything is negative 6-8%?

EDIT: Nevermind. Facility reimbursement is down. In office is going up as I had expected.

 

[mdo1738]

s

Yeah, WTF happened to the sheet that was floating around a while ago that showed an increase of almost 10%? Now everything is negative 6-8%?

Office procedure reimbursements are increased. Facility reimbursements are decreased.

 

[BoardingDoc]

s


Office procedure reimbursements are increased. Facility reimbursements are decreased.

Yeah, I was just coming back to correct my post. I misread the chart. I saw the percent decrease in the far right column coupled with the outrage above and assumed it was across the board. My bad. It does look like office procedures will be getting the increase that was previously expected.