G0260 HCPCS code: Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography
G0260 is the HCPCS Level II code for injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography. In 2024 Medicare paid an average of $230.08 per service for G0260 across 96,236 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 2 per day on outpatient hospital claims. Medicare volume rose 7% from 2022 to 2024 (89,891 to 96,236 services). In 2024, about 1,713 clinicians billed Medicare for G0260 for 50,122 beneficiaries; California, Georgia, Florida accounted for 34% of services.
Code details
| Field | Value |
|---|---|
| Section | G codes — Procedures and professional services (temporary) |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | O1E — Other drugs |
| Added | 2003-01-01 |
| Last action effective | 2004-10-01 |
Who bills G0260 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,713 |
| Medicare beneficiaries | 50,122 |
| States with claims | 47 |
| Share of services in top 3 states (California, Georgia, Florida) | 34% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for G0260, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 89,891 | 47,436 | $267.31 | $209.52 |
| 2023 | 92,682 | 48,753 | $273.30 | $214.45 |
| 2024 | 96,236 | 50,122 | $293.25 | $230.08 |
States with the most G0260 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 12,944 | $275.34 |
| Georgia | 10,361 | $220.88 |
| Florida | 9,027 | $210.69 |
| Texas | 8,060 | $222.77 |
| Maryland | 5,080 | $223.28 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 2 | Anatomic Consideration |
| practitioner claims | 2 | Anatomic Consideration |
Medicare policy articles for this code
- A59154: Billing and Coding: Sacroiliac Joint Injections and Procedures (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A59192: Billing and Coding: Sacroiliac Joint Injections and Procedures (Palmetto GBA (MAC - Part A, MAC - Part B))
- A59233: Billing and Coding: Sacroiliac Joint Injections and Procedures (National Government Services, Inc. (MAC - Part A, MAC - Part B))
- A59244: Billing and Coding: Sacroiliac Joint Injections and Procedures (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
- A59257: Billing and Coding: Sacroiliac Joint Injections and Procedures (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
Covered diagnoses (4 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| M43.28 | Fusion of spine, sacral and sacrococcygeal region | 5 |
| M46.1 | Sacroiliitis, not elsewhere classified | 5 |
| M47.818 | Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region | 5 |
| M53.3 | Sacrococcygeal disorders, not elsewhere classified | 5 |
What changed for G0260
- 2003-01-01: G0260 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code G0260?
G0260 is the HCPCS Level II code for injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography. Short descriptor: "Inj for sacroiliac jt anesth".
How much does Medicare pay for G0260?
In 2024, the average Medicare payment was $230.08 per service (average allowed $293.25).
Does Medicare cover G0260?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for G0260?
Medicare policy articles that cite G0260 list 4 covered ICD-10-CM diagnosis codes across 5 articles. The most cited include M43.28 (Fusion of spine, sacral and sacrococcygeal region), M46.1 (Sacroiliitis, not elsewhere classified), M47.818 (Spondylosis without myelopathy or radiculopathy, sacral and sacrococcygeal region). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of G0260 can be billed per day?
2 on outpatient hospital claims; 2 on practitioner claims (NCCI medically unlikely edits).
Related G02 codes
- G0202 — Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (cad) when performed
- G0204 — Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral
- G0206 — Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral
- G0219 — Pet imaging whole body; melanoma for non-covered indications
- G0235 — Pet imaging, any site, not otherwise specified
- G0237 — Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring)
- G0238 — Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring)
- G0239 — Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)
- G0245 — Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that consists of at least the following elements: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of a protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear and (4) patient education
- G0246 — Follow-up physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include at least the following: (1) a patient history, (2) a physical examination that includes: (a) visual inspection of the forefoot, hindfoot and toe web spaces, (b) evaluation of protective sensation, (c) evaluation of foot structure and biomechanics, (d) evaluation of vascular status and skin integrity, and (e) evaluation and recommendation of footwear, and (3) patient education
- G0247 — Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) to include, the local care of superficial wounds (i.e. superficial to muscle and fascia) and at least the following if present: (1) local care of superficial wounds, (2) debridement of corns and calluses, and (3) trimming and debridement of nails
- G0248 — Demonstration, prior to initiation of home inr monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the inr monitor, obtaining at least one blood sample, provision of instructions for reporting home inr test results, and documentation of patient's ability to perform testing and report results
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Next steps
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Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.