Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ)

Minimally invasive SIJ arthrodesis with placement of a transfixation device is covered only when strict clinical and imaging criteria are met, including a diagnostic SIJ block with ≥75% pain reduction, a therapeutic intra-articular SIJ injection with ≥50% pain reduction, and imaging that excludes alternative causes such as fracture, infection, tumor, traumatic instability, inflammatory arthropathy, or concomitant hip or lumbar pathology. Coverage is denied for procedures performed without a transfixation device and for patients with generalized pain disorders; documentation of block/injection results, required imaging, rehab participation, and operative confirmation of device placement must accompany the claim.

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