CPT code 64451 denotes an image-guided injection of an anesthetic and/or steroid to the nerves supplying the sacroiliac joint for diagnostic and/or therapeutic purposes. This targeted nerve block helps clinicians confirm sacroiliac joint–mediated pain and can provide short- to medium-term symptom relief. Nationally, pain management and spine-intervention services such as this are frequently reviewed by public and private payers because of utilization growth and questions about clinical indications and imaging guidance requirements. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical service represented by the code, payer coverage considerations and common modifiers, and the typical care settings where the procedure is performed. The publication also summarizes benchmarking elements and policy developments relevant to image-guided sacroiliac joint nerve blocks, and provides clinical context useful for coding, billing, and utilization review. Data not available in the input is noted where applicable.