Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ)

Covered: minimally invasive sacroiliac joint (SIJ) arthrodesis WITH placement of a transfixation device is considered medically necessary when all criteria are met; MI SIJ procedures that do not transfix the joint (non‑transfixation posterior approaches or fusion via distraction without transfixation) and any SIJ arthrodesis without a transfixation device are excluded. Key requirements: ≥6 months of SIJ‑predominant LBP below L5 unresponsive to conservative care, imaging (SIJ radiographs + CT/MRI excluding destructive lesions/fracture/instability/inflammatory arthropathy, AP pelvis radiograph, and lumbar CT/MRI) excluding other causes, absence of generalized pain disorders, ≥3 positive provocative SIJ tests, one therapeutic intra‑articular corticosteroid injection with ≥50% pain relief plus two separate image‑guided contrast‑enhanced intra‑articular SIJ injections each with ≥75% pain relief and return of function, consistent pain‑scale documentation, and exclusion of other lumbosacral diagnoses.