Sacroiliac Joint Injections and Procedures

Sacroiliac joint injections (diagnostic and therapeutic) are covered when patients have moderate-to-severe SIJ-region low back pain below L5 for ≥3 months, at least three positive provocative maneuvers, exclusion of other causes, failure of ≥4 weeks of conservative care, and diagnostic blocks produce ≥75% pain relief measured on the same scale. Diagnostic SIJIs must be image guided (CT or fluoroscopy with contrast; ultrasound only for contrast allergy or pregnancy) and are limited to 2 diagnostic sessions; therapeutic SIJIs require prior positive diagnostic response, must produce ≥50% sustained pain or functional improvement for ≥3 months, and are limited to 4 sessions per rolling 12 months. Several exclusions apply (RFA not covered, biologic injectates excluded, injections without image guidance, investigational indications such as nonspecific LBP above L5/CRPS/widespread neuropathic pain), and extensive documentation of pain scores, imaging, functional assessments, rehabilitation participation, and provider credentials is required.