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Sacroiliac joint fusion

Sacroiliac (SI) joint fusion is a surgical treatment used to address pain that originates from the joint between bones in the spine and hip (sacrum and ilium). SI joint fusion can be performed as an open procedure or as a minimally invasive procedure. It is unproven that SI joint fusion is superior to conservative management for chronic sacroiliac joint pain related to degenerative sacroiliitis and/or sacroiliac joint disruption, either de novo or after failed previous spinal surgery, in terms of safety, effectiveness or cost-effectiveness.

Coverage decision: Not Covered (Effective date: September 1, 2019)

In adults, 18 years old and older, with chronic sacroiliac joint pain related to degenerative sacroiliitis and/or sacroiliac joint disruption, minimally invasive and open sacroiliac joint fusion procedures are not a covered benefit.

Note: This decision does not apply to low back pain of other etiology (e.g., radiculopathy, neurogenic claudication), sacroiliac joint pain related to recent major trauma or fracture, infection, cancer, or sacroiliitis associated with inflammatory arthropathies.

The decision is based on a Health Technology Clinical Committee (HTCC) coverage determination finalized on May 17, 2019. The HTCC reviewed the evidence on the technology in January 2019. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that the technology is not a covered benefit. Complete information on this HTCC determination is available here: http://www.hca.wa.gov/about-hca/health-technology-assessment/health-technology-reviews.

In adopting this HTCC coverage determination, the Department has concluded that the determination does not conflict with any state statute. Any coverage for investigational treatment would be considered per WAC 296-20-02850.  Any coverage for health technologies that have a FDA Humanitarian Device Exemption status would be considered per RCW 70.14.120 (1) (b).

Regulatory authority and related information

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