Sacroiliac Joint Fusion

This policy covers sacroiliac joint (SIJ) fusion—primarily minimally invasive lateral transarticular SIJ fusion and transfixing SIJ implant stabilization—for patients with chronic unilateral low back/buttock pain when the SIJ is confirmed as the pain source, and for specific indications such as stabilization of pelvic ring disruption or as an adjunct during multi‑segment spinal constructs or sacrectomy. Coverage requires failure of conservative care (typically ≥6 months), recent imaging excluding hip pathology, fracture, tumor or neural compression, two image‑guided contrast‑enhanced intra‑articular SIJ diagnostic injections demonstrating ≥75% pain relief on two occasions and failure of at least one therapeutic SIJ injection (unless contraindicated), and is limited to lateral transarticular transfixing implants (evidence primarily for the iFuse system); non‑transfixing implants, unexcluded hip pathology, radicular pain, and other unsupported indications are not covered.