Non-Coverage for SIJ RFN

IPSIS convened the Multisociety Pain Workgroup to respond to the recent local coverage determinations (LCDs) from Medicare Administrative Contractors — CGS, Palmetto, WPS, NGS, and Noridian — misclassifying sacroiliac joint radiofrequency neurotomy (SIJ RFN) as not reasonable or necessary. These new LCDs go into effect 3/19/23.

The letters express significant concern with the determination and the implications for access to appropriate care for Medicare beneficiaries.

IPSIS is exploring additional opportunities to affect this decision and will share more information with the IPSIS membership over the coming weeks. In the meantime, an FAQ will soon be available to assist IPSIS members with navigating implementation of these new LCDs.

Of note, two MACs, Novitas and FirstCoast, have not issued any new policies related to SIJ procedures.

Click here to find your MAC.

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