Nationally, some government and private insurance plans reimburse for minimally invasive SI joint fusion, many on a case-by-case basis. A written prior authorization is recommended prior to surgery to verify coverage and benefits for the procedure.
- Medicare Coverage: Effective June 1, 2015, Medicare is reimbursing for minimally invasive SI joint fusion in 31 states (AK, AL, AR, AZ, CA, CO, DE, GA, HI, ID, LA, MD, MS, MT, NC, ND, NM, NJ, NV, OK, OR, PA, SC, SD, TN, TX, UT, VA, WA, WV, WY), and the District of Columbia. Specifically, Medicare Administrative Contractors (MACs) Cahaba GBA, Noridian Solutions, Novitas Solutions, and Palmetto GBA are reimbursing.
- Medicaid Coverage: Effective June 1, 2015, Medicaid programs are reimbursing for minimally invasive SI joint fusion in 31 states (AK, AL, AR, CT, FL, GA, IN, IA, KS, KY, LA, ME, MD, MA, MI, MN, MT, NE, NV, NH, NY, NC, ND, OH, SC, SD, UT, VA, WV, WI, WY) and the District of Columbia.
- Commercial Health Plan Coverage: Some commercial health plans reimburse for minimally invasive SI joint fusion on a case-by-case basis, including: United Healthcare, Humana, Priority Health, Health New England, Kaiser California, and Kaiser Northwest. Detailed documentation from your surgeon to meet patient selection criteria is important when supporting medical necessity requests from health plans. Contact SI-BONE’s Reimbursement Team with medical policy questions related to the procedure.
Contact SI-BONE’s Reimbursement Support Team for insurance coverage information by phone (800-710-8511) or email (PICS@si-bone.com).