1. 2020;23;439-450Utilization Patterns of Sacroiliac Joint Injections from 2000 to 2018 in Fee-for-Service Medicare Population
   Health Policy Review
   Laxmaiah Manchikanti, MD, Maanasa V. Manchikanti, ., Rachana Vanaparthy, MBBS, Radomir Kosanovic, MD, and Vidyasagar Pampati, MSc.

BACKGROUND: Sacroiliac joint is one of the proven causes of low back and lower extremity pain. Prevalence estimates of sacroiliac joint pain range from 10% to 25% in patients with persistent axial low back pain without disc herniation, discogenic pain, or radiculitis based on multiple diagnostic studies and systematic reviews. Over the years, utilization patterns of sacroiliac joint injections have been increasing in comparison to other interventional techniques. Further, the development of new current procedural terminology (CPT) codes and coverage policies for sacroiliac joint nerve blocks, sacroiliac joint radiofrequency neurotomy, and evolving evidence for sacroiliac joint fusion will further increase the utilization patterns.

STUDY DESIGN: Analysis of growth patterns of sacroiliac joint injections from 2000 to 2018 with comparative analysis of 2000 to 2009 and 2009 to 2018.

OBJECTIVES: To assess utilization patterns of sacroiliac joint injections from 2000 to 2018.

METHODS: The Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master dataset was utilized in this analysis.

RESULTS: The results of the evaluation from 2009 to 2018 showed an increase of 11.3% and an annual increase of 1.2% per 100,000 Medicare population. However, from 2000 to 2009, an increase of 299.8% from 2000 to 2009 with an annual increase of 16.6% per 100,000 Medicare population.

LIMITATIONS: The limitations of this study included a lack of data on the new sacroiliac joint nerve block and radiofrequency neurotomy codes. Further, this data did not include utilization patterns of sacroiliac joint fusions. In addition, Medicare Advantage patients were not included, which constitute approximately 30% of overall Medicare population. Further, there is also a possibility that state claims data may include claims from other states. As with all claims-based data analyses, this study is retrospective and thus potentially limited by bias. Finally, patients who are self or commercially insured are not part of the dataset.

CONCLUSIONS: This study shows increases in utilization patterns of sacroiliac joint injections; however, at a significantly lower rate with an annual increase of 16.6% prior to 2009 and only 1.2% from 2009 to 2018 per 100,000 Medicare beneficiaries

KEY WORDS: Chronic spinal pain, low back pain, sacroiliac joint arthritis, interventional techniques, sacroiliac joint injections