Skip to main content
HCPCS G0259 · Level II · G code

G0259: Injection procedure for sacroiliac joint; arthrography, HCPCS Level II G code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for G0259

Medicare payment
no PFS amount
PFS status E
Coverage code
D
special coverage instructions apply
Practitioner MUE
2
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
154
145 hospital outpatient
LCDs and articles
0 / 0

TL;DR

CMS describes HCPCS G0259, added in 2003, as "Injection procedure for sacroiliac joint; arthrography". The physician fee schedule lists G0259 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. CMS caps G0259 at practitioner 2 (MAI 3, Anatomic Consideration); hospital outpatient 2 (MAI 3, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. In the NCCI PTP files v323r0 G0259 appears in 1 practitioner pairs as column 2 and 153 as column 1 (most often with G0260), and in 1 hospital outpatient pairs as column 2 and 144 as column 1. G0259 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD. OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS O1E (other drugs); pricing indicator 00; type of service 1 (medical care). 1 other active code opens with "Injection procedure for sacroiliac joint"; related codes: G0260, G0257, G0250, G0268.

G0259 descriptor and code status

The October 2026 HCPCS Level II file describes G0259 as “Injection procedure for sacroiliac joint; arthrography”. It sits in the G section (procedures and professional services, temporary), listed with the other G codes.

HCPCS file attributes of G0259
FieldValue
Short descriptorInject for sacroiliac joint
Added to HCPCS2003-01-01
Last actionN (no maintenance), effective 2003-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator00: not separately priced by Part B
BETOS categoryO1E: other drugs
Type of service1: medical care

Medicare payment for G0259

The physician fee schedule lists G0259 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status E: excluded from the physician fee schedule by regulation. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Medically Unlikely Edits for G0259

CMS caps G0259 at practitioner 2 (MAI 3, Anatomic Consideration); hospital outpatient 2 (MAI 3, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for G0259 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services23 Date of Service Edit: ClinicalAnatomic Consideration
Facility outpatient hospital23 Date of Service Edit: ClinicalAnatomic Consideration

The MUE lookup for G0259 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

In the practitioner PTP file v323r0, G0259 is the column-2 (bundled) code in 1 active pair, 0% of which allow a modifier and the column-1 code in 153 (88% modifier-allowed); 34 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: HCPCS/CPT procedure code definition.

Column-1 codes most often paired with G0259 (practitioner)
Column-1 codePairs
G0260 Inj for sacroiliac jt anesth1
Column-2 codes bundled into G0259 (practitioner)
Column-2 codePairs
0213T (CPT; descriptor licensed by AMA)1
0216T (CPT; descriptor licensed by AMA)1
0566T (CPT; descriptor licensed by AMA)1
0596T (CPT; descriptor licensed by AMA)1
0597T (CPT; descriptor licensed by AMA)1
0708T (CPT; descriptor licensed by AMA)1
0709T (CPT; descriptor licensed by AMA)1
0903T (CPT; descriptor licensed by AMA)1

In the hospital outpatient PTP file v323r0, G0259 is the column-2 (bundled) code in 1 active pair, 0% of which allow a modifier and the column-1 code in 144 (99% modifier-allowed); 25 earlier pairs have been deleted. CMS's most frequent rationale for the bundled pairs: HCPCS/CPT procedure code definition.

Column-1 codes most often paired with G0259 (hospital outpatient)
Column-1 codePairs
G0260 Inj for sacroiliac jt anesth1
Column-2 codes bundled into G0259 (hospital outpatient)
Column-2 codePairs
0213T (CPT; descriptor licensed by AMA)1
0216T (CPT; descriptor licensed by AMA)1
0566T (CPT; descriptor licensed by AMA)1
0596T (CPT; descriptor licensed by AMA)1
0597T (CPT; descriptor licensed by AMA)1
0708T (CPT; descriptor licensed by AMA)1
0709T (CPT; descriptor licensed by AMA)1
0903T (CPT; descriptor licensed by AMA)1

G0259 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check G0259 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for G0259

No current LCD or billing and coding article lists G0259. The HCPCS coverage code D means special coverage instructions apply, and any National Coverage Determination for the service still applies.

Denials to expect on G0259

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of G0259 exceed the practitioner MUE of 2 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for G0259 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for G0259 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS G0259

What does HCPCS code G0259 describe?

"Injection procedure for sacroiliac joint; arthrography" (short descriptor "Inject for sacroiliac joint"), in the G section (procedures and professional services, temporary). Added 2003-01-01.

Is G0259 a CPT code?

It is not. G0259 belongs to the G section (procedures and professional services, temporary) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for G0259?

The physician fee schedule lists G0259 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it.

How many units of G0259 can be billed per day?

CMS caps G0259 at practitioner 2 (MAI 3, Anatomic Consideration); hospital outpatient 2 (MAI 3, Anatomic Consideration) units per day in the 2026 Q4 MUE tables. For the practitioner MUE (MAI 3), units above 2 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover G0259?

G0259 appears in no active LCD or billing and coding article, so coverage follows HCPCS coverage code D (special coverage instructions apply) and any NCD.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.