Draft LCD Deems Arthrodesis of the SI Joint Not Medically Necessary

NANS joins the Multisociety Pain Workgroup to object to Palmetto’s draft local coverage determination (LCD DL39797) for minimally invasive arthrodesis of the sacroiliac joint. Palmetto is Medicare Administrative Contractor (MAC) with jurisdiction over several states in the Southeast U.S.

Palmetto has an LCD currently, but this is an update given the new Category 1 CPT code for non-transfixing devices, 27278. Their conclusion is that SI Joint fusion without placement of a transfixation device is NOT considered medically reasonable and necessary. If this draft language is finalized, it could effectively mean that for all Medicare and Medicare Advantage cases in Palmetto jurisdiction, CPT 27278 would not be considered a covered service.