Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ)

Percutaneous minimally invasive sacroiliac joint (SIJ) arthrodesis WITH placement of a transfixation device is covered when all diagnostic and preoperative criteria are met, while MI techniques that do not transfix the joint and MI arthrodesis without a transfixation device are excluded as investigational/not medically necessary (open arthrodesis remains for revision/nonunion/aberrant anatomy). Coverage requires ≥6 months of SIJ‑predominant moderate–severe LBP below L5 with documented failure of conservative care (medication optimization, activity modification, bracing, targeted therapeutic exercise/home program), imaging that excludes destructive lesions and rules out alternate sources (SIJ radiographs + CT/MRI, AP pelvis, lumbar CT/MRI), ≥3 positive provocative SIJ maneuvers, ≥75% pain relief from image‑guided intra‑articular SIJ anesthetic injection on two separate visits and ≥50% relief from at least one therapeutic SIJ steroid injection, absence of generalized pain disorders, consistent pain‑scale documentation, and operative documentation of a transfixation device across the SIJ.