CMM-611: Sacroiliac Joint Fusion or Stabilization

Minimally invasive SIJ fusion is covered only for SI‑BONE iFuse/iFuse‑3D implants and open SIJ fusion is covered only for specified indications (post‑traumatic SIJ injury, adjunct for infection, sacral tumor, part of multisegmental long fusion, or failed prior percutaneous fusion); many other scenarios (use of non‑SI‑BONE implants, bilateral same‑day procedures, <6 months of symptoms/failed conservative care, systemic arthropathy, infection/tumor/fracture except as specified, generalized pain disorders, neural compression, acute instability, and other listed indications) are considered experimental/investigational and not covered. Key requirements: procedures must be done by a trained orthopedic surgeon or neurosurgeon using image guidance, with ≥6 months of documented conservative treatment, localized non‑radiating lumbopelvic/SIJ pain with Fortin’s point and ≥3 positive SIJ provocative tests, two fluoroscopic/CT‑guided intra‑articular SIJ blocks each showing ≥75% pain relief for the expected anesthetic duration, recent imaging excluding alternate causes, nicotine‑free status (cotinine ≤10 ng/mL), and absence of generalized pain behavior or unmanaged significant mental/behavioral health disorders.