ACR, Others Challenge MAC Position on Minimally Invasive Arthrodesis of the Sacroiliac Joint

The American College of Radiology® (ACR®) and other medical specialty societies that use or perform interventional pain and spine procedures told three of the seven Medicare Administrative Contractors (MACs) that implementation of a new policy as written could limit access to a safe, effective and durable treatment option, potentially exacerbating healthcare disparities among Medicare patients.

Celerian Group Company Administrators, LLC, Noridian Healthcare Solutions, LLC, and Palmetto GBA released final local coverage determinations (LCDs) about Minimally Invasive Arthrodesis of the Sacroiliac Joint that say, “Minimally Invasive (MI) Arthrodesis of the sacroiliac joint (SIJ) WITHOUT placement of a transfixation device is NOT considered medically reasonable and necessary.”

The College and specialty societies urge the MACs to withdraw these LCDs before April 17, when they are scheduled to take effect, and be given the opportunity to update them related to nuances in Current Procedural Terminology (CPT) codes 27278 and 27279 and reporting practices. The ACR Contractor Advisory Committee Network representatives continue to monitor local coverage activities and address concerns that will adversely impact the interventional radiology community.  

For more information about local coverage determination activities or questions, contact Alicia Blakey, ACR Principal Economic Policy Analyst.