Payers continue to expand coverage for SI joint fusion

Spine

This year saw more spine surgeons, device companies and payers hone in on minimally invasive sacroiliac joint fusions.

In January 2020, CMS upped the reimbursement rate for MIS joint fusions by 27 percent and increased the work relative value units associated with the CPT 27279 from 9.03 to 12.13. As a result, pay for the procedure rose from $720 to $915.

Coinciding with CMS' increased payment, 2020 saw many SI joint fusion product developments and more payers expand coverage for the procedure with SI-Bone's iFuse. 

Four key updates:

1. In December, Humana widened its coverage policies to include MIS joint fusion using triangular titanium implants, which covers SI-Bone's iFuse system. The policy covers MIS SI joint fusion for chronic low back pain due to SI joint dysfunction, provided certain criteria are met.

2. Medica, a Minneapolis-based insurer, revised its coverage policy to include MIS SI joint fusion with SI-Bone's iFuse Implant in August.

3. In May, a new Aetna policy began covering minimally invasive arthrodesis of the SI joint.

4. Though SI-Bone is widely considered the leader in the SI joint fusion, many device companies increased their focus on the field this year. Aurora Spine, Genesys Spine and Tenon Medical are among the companies that completed new product designs, launches and clinical trials this year.

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