Sacroiliac Joint Interventions

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UnitedHealthcare Commercial Medical Policy Sacroiliac Joint Interventions Policy Number: 2021T0621B. Effective Date: November 1, 2021 Instructions for Use Table of Contents Page Related Commercial Policies Coverage Rationale ........................................ ............................... 1 Ablative Treatment for Spinal Pain Documentation Requirements ........................................ .............. 2 Epidural Steroid Injections for Spinal Pain Definitions ........................................ ........................................ ...... 2. Facet Joint Injections for Spinal Pain Applicable Codes ........................................ .................................. 3. Description of Services ........................................ ......................... 3 Community Plan Policy Clinical Evidence ........................................ ................................... 4 Sacroiliac Joint Interventions Food and Drug Administration.

Axial Skeleton: In the human body, the bones of the body axis, including the skull, vertebral column, ribs, and sternum. Titanium Triangular Implant: A ®Sacroiliac Joint (SIJ) implant (e.g., iFuse Implant System ) intended for treating low-back pain ... guidance (i.e., fluoroscopy or computed tomography) CPT ...

  Body, Tomography, Computed, Computed tomography