Learn

How Does iFuse Reimbursement Work?

Navigating the healthcare reimbursement process to get reimbursement for your iFuse procedure can be confusing and frustrating. Working with the appropriate people and gathering the right information can make it easier.


Tips for a Successful Application

Here are some tips to consider as you begin seeking coverage for the iFuse Implant procedure:

1. Know your healthcare insurance benefit plan administrator.

Contact your insurance provider and ask if your specific plan includes coverage for the iFuse Implant procedure:

CPT Code 27279 – Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixed devise.*

2. Determine whether your plan is “administrative only/self-funded” or is a standard benefit plan such as an HMO/PPO.

Administrative only/self-funded plans means that the employer ultimately pays for the requested medical services and not the insurance company administering the policy. This important factor will determine who ultimately decides on your appeal.

Some employers require that you exhaust your appeal process with the administrative-only plan first before they will consider overturning your denial. Be sure to understand exactly what kind of plan your employer has established by obtaining a copy of your employee benefit plan.

In many cases, the employer will provide you with additional guidance when faced with an insurance denial.

3. Contact the medical facility or surgeon’s office reimbursement administrator.

This person can advise you on how long it should take to secure the prior authorization for the iFuse Implant procedure and serve as the point of contact for apprising you of the status of your pre-authorization and/or appeal.

If your request is denied, this person, with your surgeon, can intervene on your behalf with the payer to explain your specific needs for the iFuse procedure.

4. Contact SI-BONE patient support resources.

If you are experiencing an insurance denial, SI-BONE's patient insurance coverage support (PICS) can help facilitate access to iFuse. Call 800-710-8511 or email PICS@si-bone.com.

* CPT 2015 Professional Edition. American Medical Association. Page 142.

Looking for Answers?

We can help. Tell us what you're looking for below.