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If the member experiences no symptom relief or functional improvement after 2 sacroiliac joint injections, additional sacroiliac joint injections are not considered medically necessary.

Once the diagnosis is established, it is rarely medically necessary to repeat sacroiliac injections more frequently than once every 2 months.

Most authors indicate that a limit on number of injections is appropriate, and that most patients will respond with 3 or fewer injections.

The American Academy of Neurology's assessment on the use of epidural steroid injections in the treatment of radicular lumbosacral pain (Armond et al, 2007) concluded that: Guidelines from the American Pain Society (Chou et al, 2009) questioned the clinical value of epidural injection for long-term use or for use of non-radicular back pain.

If the diagnostic phase is completed and unsuccessful, additional epidural injections are considered not medically necessary.

Even if pain relief is temporary, it may have long-term benefit because it allows initiation of physical therapy or other rehabilitative measures at an earlier stage.Trigger point injections are considered experimental and investigational for all other indications because their effectiveness for indications other than the ones listed above has not been established.A trigger point is defined as a specific point or area where, if stimulated by touch or pressure, a painful response will be induced.Repeat injections extending beyond 12 months may be reviewed for continued medical necessity.Ultrasound guidance of sacroiliac joint injections is considered not medically necessary.

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