ACR, Pain Management Societies Disappointed in Coverage Limitations for Sacroiliac Joint Injections

The American College of Radiology® (ACR®) and several pain management societies expressed disappointment to five of seven Medicare Administrative Contractors (MACs) after learning the MACs eliminated access to sacroiliac joint radiofrequency ablation for Medicare beneficiaries in their latest final local coverage determination (LCD). This procedure is proven to be safe and effective in providing pain relief and functional improvement in appropriately selected patients.

In a letter sent March 7, the College and societies reiterated their support of coverage for sacroiliac interventions for pain management and provided a detailed explanation of its importance to patients’ quality of life over the past year. Prohibiting access to sacral lateral branch radiofrequency neurotomy will leave patients with only surgery or opioids as their alternative covered treatment options.

Despite a collaborative effort to encourage coverage for sacroiliac joint radiofrequency ablation, the MACs insist there is a lack of established practice standards, patient selection, assessment criteria and frequency of treatment. Furthermore, long-term outcomes have not been established in the existing literature.

ACR encourages members to review the final LCD policy and associated billing and coding article as the policy is effective for services performed on or after March 19. Be sure to notify your appropriate billing and coding staff to avoid future claim denials. Once the final policy is effective, a formal LCD reconsideration would need to be submitted to the MAC with supporting literature to overturn their decision.

If you have questions or would like more information about local coverage policies and activities, contact Alicia Blakey, ACR Principal Economic Policy Analyst.