Does Medicare Cover SI Joint Fusion?
Fair Square Medicare

Does Medicare Cover SI Joint Fusion?

Caucasian nurse holding spine model against the patients backs. Clinic interior. stock photo

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.

Stay up to date on Medicare

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.

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.

Stay up to date on Medicare

Join the Fair Square Medicare Newsletter to stay informed on cost savings, changes to Medicare, and other valuable healthcare information.


Learn More About Medicare

heart surgery stock image

How Much Does Open Heart Surgery Cost with Medicare?

2023-01-27

senior african american man feeling pain in his knees from arthritis while on a couch stock photo

How Much Does Xeljanz Cost with Medicare?

2023-01-25

Doctor talking to patients are explaining the treatment of a patient's illness stock photo

How Much Does Rexulti Cost with Medicare?

2023-01-24

Human hands holding healthy lung shape made from paper on light blue background. stock photo

How Much Does Trelegy Cost with Medicare?

2023-01-24

Female physiotherapist helping elderly man in wheelchair do exercises with dumbbells at health center stock photo

What Does Medicare Cover for Stroke Patients?

2023-01-20

Doctor demonstrating upper cervical spine anatomy stock photo

Does Medicare Cover Cervical Disc Replacement?

2023-01-20

Medicare Set Aside funds stock image

What Happens to Unused Medicare Set-Aside Funds?

2023-01-20

older man suffering from stomach pain due to IBS stock photo

Does Medicare Cover Xiafaxan?

2023-01-19

senior woman doing botox stock photo

Is Botox Covered by Medicare?

2023-01-19

Health insurance form on a table with pen, calculator and glasses stock image

What You Need to Know About Creditable Coverage

2023-01-18

Acute psoriasis on elbows is an autoimmune incurable dermatological skin disease stock photo

Does Medicare Cover Light Therapy for Psoriasis?

2023-01-17

wart on the sole of a white man's foot stock photo

Does Medicare Cover Wart Removal?

2023-01-17

woman sitting on sofa feeling pain in her foot at home stock photo

Does Medicare Cover Qutenza?

2023-01-13

Nasal spray stock image

Can Medicare Help with the Cost of Tyrvaya?

2023-01-12

Gloved hands with a scalpel begin a knee replacement surgery

Does Medicare Cover Iovera Treatment?

2023-01-11

A doctor with a clipboard consults a female patient with cancer

Does Medicare Cover Inqovi?

2023-01-11

Physiotherapist showing workout record on exercise bike

Does Medicare Cover Exercise Physiology?

2023-01-11

A women's restroom sign that has been modified to show the stick figure woman needing to use the toilet

Does Medicare Cover Bladder Sling Surgery?

2023-01-11

Your Medicare One-Stop-Shop

Your guide to Medicare Parts A & B, Medicare Advantage, and Medigap.

100% free.

Fair Square Medicare

LEGAL

Privacy Policy

CONTACT

1-888-454-2383

MORE


Virgil Insurance Agency, LLC (DBA Fair Square Medicare) and www.fairsquaremedicare.com are privately owned and operated by Help Button Inc. Medicare supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. This is a solicitation of insurance. A licensed agent/producer may contact you. Medicare Supplement insurance is available to those age 65 and older enrolled in Medicare Parts A and B and, in some states, to those under age 65 eligible for Medicare due to disability or End-Stage Renal disease. Virgil Insurance Agency is a licensed and certified representative of Medicare Advantage HMO, HMO SNP, PPO, PPO SNP and PFFS organizations and stand-alone PDP prescription drug plans. Each of the organizations we represent has a Medicare contract. Enrollment in any plan depends on contract renewal. The plans we represent do not discriminate on the basis of race, color, national origin, age, disability, or sex. Plan availability varies by region and state. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov. © 2022 Help Button Inc

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

MULTIPLAN_FairSquareMedicare_01062022_M