Effective March 19, 2023, Medicare has created a new policy for Sacroiliac Joint Procedures. Several states did not previously have a policy for these procedures, and with the creation of the new policy, not following the items outlined could result in audits and payment recoupments. As a practice, you must ensure you are scheduling and documenting appropriately to capture the necessary information listed in the new policy to prevent takebacks by Medicare. The new rules and regulations outline different areas, such as required post-procedure relief, specific diagnoses allowed, and the exclusion of previously paid procedures that are now not covered. Below are a few of the specifics:

1. SI RFA is non-covered.
2. KX modifier must be added to all diagnostic procedures max of two allowed
3. Three positive provocative maneuvers.
     a. FABER
     b. Gaenslen
     c. Thigh Thrust or Posterior Shear
     d. SI Compression
     e. SI Distraction and Yeoman Tests 
4. Must maintain two films: final needle position and contrast flow.
5. Pre and post-pain percentage
6. Therapeutics must receive 50% relief lasting three months. 

Medicare Administrative Contractors who have adopted the policy so far:

1. CGS Administrators
2. National Government Services
3. Palmetto GBA
4. Noridian Healthcare Solutions
5. WPS Insurance Corporation