Sacroiliac Joint Injections and Procedures (L39462) - R1 - Effective March 19, 2023

Date Posted: February 5, 2026

This Local Coverage Determination (LCD) has been revised under contractor numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

Effective Date: March 19, 2023

Summary of Changes:

SUMMARY OF EVIDENCE:

Added: A different procedure called cryoanalgesia, has been proposed for SIJ pain.

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