SI Joint Injections and LCDs: Navigating New Boundaries in Pain Medicine

The recent Local Coverage Determination (LCD) regarding sacroiliac (SI) joint procedures significantly restricts patient access to sacral lateral branch radiofrequency ablation (RFA) and imposes stringent, often arbitrary, documentation requirements for SI joint injections. Experts Dr. Zach McCormick, Dr. Lynn Kohan, and Dr. Steve Cohen argue that this policy shift contradicts robust, level-one evidence supporting RFA as a safe, effective, and minimally invasive treatment. By removing RFA coverage, the mandate forces clinicians toward more invasive and costly alternatives like SI joint fusion, which may not be appropriate for all patients. This policy highlights a critical need for the pain medicine community to unify its voice and advocate for evidence-based coverage policies that prioritize patient-centered care over administrative mandates that lack clinical justification.