2023 Update to CMS’ Covered Indications for Sacroiliac Joint Injection
2023 Update to CMS’ Covered Indications for Sacroiliac Joint Injection
Episode 280
May 2, 2023
023 Update to the Sacroiliac Joint
CMS Covered Indications for SI Joint Injection
Long Island Based Interventional Pain Physician, David Rosenblum, MD discusses Sacroiliac Joint Dysfunction, and CMS’s Covered Indications for Sacroiliac Joint Injection and Diagnostic Nerve Block
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Sacroiliac Joint Injections are considered necessary and reasonable when all of the following criteria are met:
Moderate to severe low back pain primarily experienced over the anatomical location of the SI joints between the upper level of the iliac crests and the gluteal fold, AND
Low back pain duration of at least three (3) months, AND
Low back pain below L5 without radiculopathy, AND
Clinical findings and/or imaging studies do not suggest any other diagnosed or obvious cause of the lumbosacral pain (such as central spinal stenosis with neurogenic claudication/myelopathy, foraminal stenosis or disc herniation with concordant radicular pain/radiculopathy, infection, tumor, fracture, pseudoarthrosis, or pain related to spinal instrumentation), AND
At least three positive findings with provocative maneuvers: FABER, Gaenslen, Thigh Thrust or Posterior Shear, SI Compression, SI Distraction and Yeoman Tests,3,4 AND
Low back pain persists despite a minimum of four weeks of conservative therapies.5