Transcription of Local Coverage Determination for Sacroiliac Joint ...
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Local Coverage Determination for Sacroiliac Joint ...
Local Coverage Determination (LCD) for Sacroiliac JointInjection (L29274)Contractor InformationContractor NameFirst Coast Service Options, Number09102 Contractor TypeMAC - Part BBack to TopLCD InformationDocument InformationLCD ID NumberL29274 LCD TitleSacroiliac Joint InjectionContractor's Determination Number27096 AMA CPT/ADA CDT Copyright StatementCPT codes, descriptions and other data onlyare copyright 2011 American MedicalAssociation (or such other date of publicationof CPT). All Rights Reserved. ApplicableFARS/DFARS Clauses Apply. Current DentalTerminology, (CDT) (including procedurecodes, nomenclature, descriptors and otherdata contained therein) is copyright by theAmerican Dental Association.
N/A Indications and Limitations of Coverage and/or Medical Necessity The sacroiliac (SI) joint is formed by the articular surfaces of the sacrum and iliac bones.
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