Proposed update: 5 MACs mull a new policy for sacroiliac joint blocks, RFA

Why This Topic Matters

Proposed LCDs can change what services are covered, how claims must be documented, and which billing practices are acceptable across multiple Medicare contractors. Reviewing the policy early helps organizations assess operational impact and prepare for comments, workflow updates, and compliance review.

Article Sections

1. Overview of the proposed uniform LCD and companion article

   Introduces the multi-MAC policy effort and the procedures addressed by the proposed coverage update. Notes the contractors involved and the general purpose of the companion article.

2. Covered and non-covered procedures

   Summarizes the procedure categories addressed by the proposal and distinguishes services discussed as covered versus not covered under the draft policy.

3. Medical necessity restrictions and requirements

   Describes the broad medical-necessity framework, including symptom duration, conservative treatment expectations, imaging expectations, and follow-up considerations.

4. Take note of the frequency limits

   Outlines the proposed utilization limits for diagnostic and therapeutic sessions and notes how the policy frames session counting.

5. More coding guidance

   Covers the companion article’s billing and modifier guidance at a high level, along with diagnosis-code support references and the MAC comment-period summary.