Sacroiliac Joint Interventions – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers image‑guided intra‑articular SIJ injections when InterQual® criteria are met; open SIJ fusion is covered only for pelvic ring trauma/fracture, tumor reconstruction, as an adjunct for infection/sepsis, or as part of multisegmental spinal deformity constructs, while sacral lateral branch blocks and minimally invasive fusion with devices other than the Titanium Triangular Implant System (iFuse‑type) are considered investigational/not medically necessary. Coverage of minimally invasive SIJ fusion with the Titanium Triangular Implant System requires documented ≥6 months of failed intensive nonoperative care (medication optimization, activity modification, targeted exercise), a nonradicular unilateral SIJ pain pattern with localized tenderness and ≥3 positive provocative tests, imaging excluding other causes, two image‑guided contrast‑enhanced diagnostic intra‑articular SIJ injections each producing ≥75% pain relief (and a trial of at least one therapeutic steroid injection), with medical-record documentation per InterQual® and policy requirements.