Medicare local coverage
Medicare coverage for Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ) (LCD)
3 Medicare Administrative Contractors publish a local coverage determination (LCD) for Minimally Invasive Arthrodesis of the Sacroiliac Joint (SIJ). The snapshot lists 4 LCD records: 3 active, 1 retired.
An LCD applies only in the jurisdiction of the contractor that wrote it. Two contractors can cover the same service with different criteria, documentation requirements and covered diagnoses, so check the LCD from the contractor that processes your claims.
LCDs by contractor
| Contractor | LCD | Status | Last updated |
|---|---|---|---|
CGS Administrators, LLCMAC - Part A, MAC - Part B | L39802 | Active | May 9, 2025 |
Noridian Healthcare Solutions, LLCMAC - Part A, MAC - Part B | L39812 | Retired Oct 23, 2025 | Oct 23, 2025 |
Noridian Healthcare Solutions, LLCMAC - Part A, MAC - Part B | L39810 | Active | Oct 14, 2025 |
Palmetto GBAMAC - Part A, MAC - Part B | L39797 | Active | Jun 12, 2025 |
An LCD marked Future has been finalized and is in its notice period; it applies from the effective date shown. LCD IDs link to the record on cms.gov.
Billing and coding articles
The codes live in the billing and coding article that goes with each LCD: the CPT and HCPCS codes the policy applies to, the ICD-10 codes that support medical necessity, and any modifier or documentation rules.
- A59672Palmetto GBAUpdated Jan 27, 2026
- A59682CGS Administrators, LLCUpdated Dec 27, 2024
- A59695Noridian Healthcare Solutions, LLCUpdated Dec 23, 2025
- A59697Noridian Healthcare Solutions, LLCUpdated Oct 23, 2025
CMS also lists 4 response-to-comments articles for this topic, where contractors answer public comments on the proposed LCD: A59948, A59957, A59961, A59962.
Check claim lines against Medicare coverage
Coverage Check tells you whether a claim's diagnoses support Medicare LCD or NCD coverage for each procedure line, and shows the policy and CMS source behind each answer.
Related LCD topics
- Minimally-invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint
- Percutaneous minimally invasive fusion/stabilization of the sacroiliac joint for the treatment of back pain
- Sacroiliac Joint Injections and Procedures
- Select Minimally Invasive GERD Procedures
- Facet Joint Interventions for Pain Management
- Lower Extremity Major Joint Replacement (Hip and Knee)
All Medicare LCD topics · National coverage determinations · Payer policies by payer
Source: CMS Medicare Coverage Database, via the public CMS Coverage API, snapshot Oct 25, 2026. LCDs change between snapshots; confirm the version in effect for your date of service on cms.gov before billing.