Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ)

MI sacroiliac joint arthrodesis is covered only when performed with placement of a transfixation device and when the patient meets strict diagnostic and therapeutic criteria, including a diagnostic SIJ block with ≥75% pain relief, at least one therapeutic SIJ corticosteroid injection with ≥50% pain relief, and appropriate SIJ, pelvis, and lumbar imaging that excludes alternative causes or contraindicating pathology. Coverage requires absence of generalized pain disorders and active participation in a rehabilitation or functional restoration program; procedures performed without a transfixation device are not covered.

"Minimally invasive (MI) arthrodesis of the sacroiliac joint (SIJ) with placement of a transfixation device is covered when all other listed criteria are met."

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