Billing and Coding: Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ)

This billing and coding guidance supplements Local Coverage Determination L39802 for minimally invasive sacroiliac joint (SIJ) arthrodesis: the procedure is billable only when the patient's condition meets the LCD's medical necessity criteria. Claims must include a valid ICD-10-CM diagnosis code, and for services requiring a referring/ordering physician the referring provider name and NPI must be reported; codes may be subject to NCCI and OPPS edits. Medical records must document medical necessity (history, physical exam, diagnostic test results) and be available to Medicare on request.

"Minimally invasive sacroiliac joint (SIJ) arthrodesis may be billed when the procedure is performed and the patient's condition meets the medical necessity and coverage criteria in Local Coverage D..."

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