National Government Services, the Medicare Administrative Contractor (MAC) for ten US states, has issued a positive local coverage determination (LCD) for minimally invasive sacroiliac joint fusion surgery. The LCD will come into effect on 1 April 2016.
The LCD will cover the states of Connecticut, Illinois, Maine, Massachusetts, Minnesota, New Hampshire, New York, Rhode Island, Vermont and Wisconsin. There are a total of eight MACs responsible for over 50 million Medicare beneficiaries across the USA. This contractor will become the seventh MAC to provide coverage for MIS SI joint fusion, adding 9.5 million beneficiaries to the total that will be able to access this surgery. This will bring the total number to more than 45 million beneficiaries in 49 states, and will leave First Coast Service Options of Florida the only MAC yet to provide coverage for MIS SIJ fusion surgery.
According to a SI-Bone press release, the policy is based on evidence from more than two dozen of the clinical publications demonstrating the safety and effectiveness of MIS SI fusion surgery which “consistently show improved pain scores with fewer complications than open fusion in patients with non-infectious, non-traumatic related SI pain”. These studies used the company’s iFuse sacroiliac joint fusion system. The release also asserts that the decision was informed by positive medical professional society coverage recommendations from the North American Spine Society (NASS) and the International Society for the Advancement of Spine Surgery (ISASS).