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Neurology & Pain Management Coding Alert

Reader Question:

Sacroiliac Joint Injections

Published on Tue May 01, 2001

Question: I need help with developing a charge for 27096. Our neurologist believes that our current fee is too much. How much should we charge and what is the reimbursement?

Hawaii Subscriber

Answer: Reimbursement for 27096 (injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid) varies. For example, in some states Medicares RVU for this procedure in the hospital is 1.55 but in the office setting it is 11. In Utah, the Medicare allowable for 27096 in a facility is $73.33 and the allowable in the office is $446.33. To find out what is an appropriate charge, you need to contact your local Medicare carrier and your top-five third-party payers and find out what their reimbursement is. You can then use those amounts as a guide.
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