Medicare Administrative Contractor (MAC), First Coast Service Options (FCSO), which covers the state of Florida as well as Puerto Rico and the US Virgin Islands, has established coverage criteria for minimally invasive sacroiliac joint fusion. This is the last MAC to agree coverage for the procedure.
FCSO “has removed Current Procedural Terminology code 27279 from the Noncovered Services Local Coverage Determination (L33777) for services rendered on or after June 16, 2016 and will be considered for coverage on a case-by-case basis for the treatment of chronic back pain for certain patients, assuming all other applicable program requirements are met.”
According to a press release from SI-Bone, coverage criteria were based on the North American Spine Society’s (NASS) Coverage Policy Recommendations. FCSO becomes the eighth and final MAC to provide access to coverage for minimally invasive sacroiliac joint fusion. Medicare beneficiaries in all 50 states and the District of Columbia have access to this surgery.