Policy & oversight
OIG: Medicare Paid an Estimated 15.2 Million Dollars for Incorrectly Coded Sacroiliac Joint Injections
A federal audit found that roughly 72 percent of sampled Medicare claims for the procedure used the wrong billing category, with physicians repeatedly coding diagnostic injections as the higher-paid therapeutic type.
By the Goodsurance editorial teamOctober 22, 2026
The Department of Health and Human Services Office of Inspector General found that Medicare made an estimated 15.2 million dollars in improper payments for sacroiliac joint injection sessions performed between October 1, 2023, and September 30, 2024, according to a report published in August 2026.
Auditors reviewed a sample of 100 claims and found that 72 did not meet Medicare requirements. Extrapolating to all 186,842 sessions billed during the review period, the OIG estimated that about 134,526 sessions were improperly paid.
OIG found 72% of sampled Medicare sacroiliac injection claims used the wrong billing code, costing an estimated 15.2 million dollars in improper payments in one year.
The most common error was a coding mismatch: physicians billed 46,711 sessions as therapeutic injections when those procedures should have been classified as diagnostic. Medicare pays different rates for the two categories, and using the higher-paid code inflates reimbursement.
The OIG made three recommendations to the Centers for Medicare and Medicaid Services. The first two asked CMS to work with its Medicare administrative contractors to develop targeted provider education on correct billing practices, and to add automated claims edits that would flag potential miscoding before payment. CMS agreed to both. A third recommendation, calling for additional technical safeguards to prevent diagnostic injections from being coded as therapeutic, was rejected by CMS, which said its existing guidance was sufficient.
Sacroiliac joint injections are used to diagnose and treat lower-back and hip pain, and Medicare covers both the diagnostic and therapeutic versions under separate billing codes. The OIG concluded that oversight by CMS and its contractors had not been adequate to prevent the billing pattern before the audit was conducted.
In plain words
Government inspectors checked Medicare bills for a procedure that helps with back and hip pain. They found that doctors billed Medicare the wrong way more than 130,000 times in a single year. The most common mistake was labeling a lower-cost type of injection as a higher-cost one. This cost Medicare an estimated 15.2 million dollars more than it should have paid. The government watchdog told Medicare to train doctors better on billing rules and to fix its computer checks so errors get caught before payment goes out. Medicare agreed to two of those three fixes but rejected the third.
Understand the basics first
Source: HHS OIG
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