Wiki Radiofrequency Ablation of the Sacroiliac Joint

[rmmohler!]

I work for a pain management group and the question has come up if insurance will cover an SI joint radiofrequency. I know for certain it is considered investigational by one insurance but have not been able to find a policy with Medicare for codes 64450, 64635, and 64640. So I am interested in finding out if anyone has been billing and getting reimbursment for this procedure.

 

[dwaldman]

Per the WPS Medicare J5 LCD for Sacroilliac Joint Injections, they do not cover it. Possibly review if there is an LCD for the Medicare contractor you bill.

Limitations
Pulsed radiofrequency for denervation is considered investigational and therefore, not medically necessary.

Sacro-iliac joint/nerve denervation procedures are also considered investigational and not medically necessary.

It is not appropriate to use code 20610, Arthrocentesis, aspiration and/or injection; major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa) for SI joint injections.