Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ) (L39810) - R2 - Effective April 17, 2025

Date Posted: October 9, 2025

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: April 17, 2025

Summary of Changes: Coverage Indications, Limitations and/or Medical Necessity - Covered Indications: A.1. - Corrected the LCD number for Sacroiliac Joint Injections and Procedures to L39462

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Last Updated Oct 09 , 2025