Kentucky and Ohio, USA, Medicare Administrative Contractor to provide coverage for minimally invasive sacroiliac joint fusion


The Medicare Administrative Contractor (MAC) covering the US states of Kentucky and Ohio has issued a positive local coverage determination (LCD) for minimally invasive (MIS) sacroiliac joint fusion. This coverage, which should give 2.8 million beneficiaries access to this surgery, will become effective on the 1st February 2016.


CGS Administrators, LLC have become the 6th MAC to provide coverage for MIS SI joint fusion, bringing the total number of Medicare-covered lives to almost 30 million.


This policy decision is based on the combination of clinical evidence and professional society coverage recommendations. A number of clinical publications have been published demonstrating the safety and effectiveness of SI joint fusion (here using the SI-Bone iFuse device) that “consistently show improved pain scores with fewer complications than open fusion in patients with non-infectious, non-traumatic related SI pain”. Positive medical professional society coverage recommendations have come from the North American Spine Society (NASS) and the International Society for the Advancement of Spine Surgery (ISASS).


According to a SI-Bone press release, the iFuse Implant System is the only MIS SI joint fusion device cleared by the FDA with an indication citing clinical studies that demonstrated improved pain, patient function and quality of life out to 12 months post-implantation.


“This…creates access for numerous Medicare beneficiaries in need of this treatment,” says Michael Mydra, vice president, Health Outcomes & Reimbursement, SI-Bone.