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Sacroiliac Joint Interventions

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 .. 8. References .. 8. Policy History/Revision Information.

• Epidural Steroid Injections for Spinal Pain ... Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography . Description of Services . Sacroiliac (SI) Joint Fusion is a surgical procedure, which fuses the iliac bone (pelvis) to the spine (sacrum) for stabilization. ...

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