CMM-203: Sacroiliac Joint Procedures

Diagnostic and therapeutic intra‑articular SI joint injections with anesthetic, corticosteroid and contrast (performed under fluoroscopy) are covered when pain is localized between the iliac crests and gluteal fold, other causes are excluded, ≥3 specified provocative tests reproduce pain, and the patient has failed ≥4 weeks of conservative care with active rehabilitation; ultrasound guidance, biologic injectates (PRP, stem cells, etc.), L5/sacral lateral branch procedures, injections without appropriate imaging guidance, same‑day other spine injections, >4 injections per joint/12 months or injections more frequent than every 2 months are investigational or not medically necessary. Key requirements: diagnostic blocks must produce ≥75% pain relief to justify therapeutic treatment, therapeutic/repeat injections require ≥75% relief plus improved function or reduced medication/use for ≥2 weeks, a minimum 2‑month interval between injections, and intra‑articular procedures should use fluoroscopy with contrast (unless contraindicated).