Does Medicare Cover SI Joint Fusion?

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By Daniel Petkevich

Nov 28, 2022

Medicare has your back

Your sacroiliac joint, or SI Joint, is one of the more overlooked parts of the body that can cause unexpected pain. If you are experiencing pain, an SI joint fusion is one of the more popular new procedures in relieving this pain. The good news is you'll have Medicare coverage if you need it.

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What is sacroiliac joint dysfunction?

Sacroiliac joint dysfunction is an issue caused by a misalignment of the sacroiliac joints in your lower back. These joints connect your spine and pelvis together, and when they become inflamed or irritated, it can cause pain, stiffness and limited mobility.

What is SI joint fusion surgery?

SI joint fusion is a surgery used to treat chronic pain caused by sacroiliac joint dysfunction. The aim of the surgery is to eliminate movement in the area and provide long-term pain relief. During SI joint fusion, the surgeon will remove damaged bone from the affected area and replace it with a grafting material, such as metal implants or donor bone. In some cases, screws and rods may be used to hold the bones in place.

What are the risks and benefits of SI joint fusion surgery?

SI joint fusion surgery carries some risks, including infection, nerve injury and blood clots. Patients should discuss the risks with their doctor before undergoing this procedure to make sure they understand what they are getting into.

The benefits of SI joint fusion surgery include long-term relief from chronic pain and improved mobility in the area. Many patients who undergo SI joint fusion report a marked improvement in their quality of life.

How does Medicare cover SI joint fusion surgery cost?

Medicare covers SI joint fusion in certain circumstances. Generally speaking, Medicare Part B will provide coverage for SI joint fusion if it is deemed medically necessary by your doctor and is performed by an approved healthcare provider. Medicare will pay 80% of the fee if it's done in an outpatient facility. On average, you can expect to pay $1,728 in out-of-pocket costs, according to Medicare.gov. You could get more coverage on out-of-pocket costs if you have a Medicare Supplement Plan G.

How to know if you need SI joint fusion surgery?

The best way to know if you need SI joint fusion surgery is to consult with your doctor. Your doctor can help you determine whether or not this procedure is the right option for you and discuss any other treatment options that might be available.

What happens after surgery?

After SI joint fusion surgery, your doctor will likely recommend a period of rest and physical therapy. It may take some time for the area to heal fully; however, many patients report improved mobility and pain relief after undergoing this procedure.

Alternatives to SI joint fusion surgery

SI joint fusion surgery isn't the only option for treating sacroiliac joint dysfunction. Other treatment options may include physical therapy, medications, and lifestyle changes such as diet and exercise. In some cases, these non-surgical treatments can provide significant relief.

Takeaway

SI joint fusion is a surgery used to treat chronic pain caused by sacroiliac joint dysfunction. Medicare Part B typically covers this procedure when it is deemed medically necessary. Before undergoing SI joint fusion, you should talk to your doctor about the risks and benefits of the procedure to see if it's right for you. This content is for informational purposes only. If you have any questions about your Medicare plan, give us a call to speak with a Medicare expert today.

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