This is a patient demand report for spine and pain practice owners and marketing leads. It shows what patients pay for sacroiliac (SI) joint fusion and SI joint radiofrequency ablation, what Medicare pays your practice, what the evidence says, and what patients find when they search before they call. The practice-side facts come first; the patient detail below is the evidence behind them.
For practice owners: what this search looks like from your side
Some facts, side by side.
In a national claims database covering 20,448 patients from 2020 to early 2023, ablation was the more common procedure, 12,581 patients against 7,597 for fusion. The gap was closing. Ablations fell by an average of 155 procedures a quarter while fusions rose by an average of 331 a quarter. (Clinical Spine Surgery, 2026)
The Medicare contractors whose SI joint policies I read, WPS, Noridian and CGS, each state that SI joint denervation, “also called Radiofrequency Ablation or RFA,” is not considered reasonable and necessary. (WPS L39475, Noridian L39462, CGS L39383) Minimally invasive fusion with an implant that crosses the joint is covered when a patient meets a list of criteria. (Noridian L39812)
The 2026 Medicare fee schedule still prices both. A minimally invasive fusion in a hospital outpatient department comes to about $18,673 for facility and surgeon together. An ablation in the same setting comes to about $2,172.
When I reviewed the pages that rank for this comparison, almost every result was a study or a case report. No practice page I found put a price on both procedures.
What those mean together for your practice is for you to work out. If you advertise spine procedures, my page on Google Ads costs for spine surgeons covers the paid side.
If you want to see how your SI joint pages answer that question today, book a 30-minute call. I will look at your site and your market before we talk. You can also read what a page like this is worth to an orthopedic practice.
What patients pay
When I reviewed the pages that rank for this comparison, the results were a 2026 claims study, a 2016 cost-effectiveness model, a 2021 state evidence report, case reports and trial registrations, and one patient education site. The only dollar figures were inside the cost model. None put a cash price, Medicare rates and the head-to-head evidence on one page.
On MDsave, a site where patients prepay a set price, SI joint fusion listings ran from $21,685 to $42,607 when I checked on 4 October 2026, with an MDsave national average of $33,624. (MDsave SI joint fusion) Radiofrequency ablation listings ran from $732 to $5,962, with an MDsave national average of $3,558. That listing covers ablation in general and does not say which joint is treated. (MDsave radiofrequency ablation)
Ablation is a needle procedure that targets the small nerves carrying pain from the joint. In the 2008 placebo-controlled trial below, relief had faded for most treated patients by one year. Fusion places implants across the joint to stop it moving and is meant to be permanent.
Medicare patients face a second gap. Under the contractor policies above, ablation of the SI joint is not covered, so Medicare will not pay for it in those jurisdictions. Fusion with a transfixing implant is covered when the criteria are met.
What Medicare pays your practice
Medicare pays the facility and the surgeon separately, so the figures add together.
| Minimally invasive SI joint fusion | SI joint radiofrequency ablation | |
|---|---|---|
| Procedure code | CPT 27279 | CPT 64625 |
| Medicare 2026 surgeon fee, facility setting | $758.53 | $176.69 |
| Medicare 2026 surgeon fee, office setting | Not payable in office | $495.67 |
| Medicare 2026 hospital outpatient payment | $17,914 (Level 6 musculoskeletal) | $1,995 |
| Medicare 2026 surgery center rate | $14,518, as a device-intensive procedure | $949 |
| Medicare 2026 inpatient hospital payment | $23,507 (MS-DRG 451), $38,782 with major complications (MS-DRG 450) | Not applicable |
| Medicare coverage (WPS, Noridian, CGS policies) | Covered when criteria are met | Not considered reasonable and necessary |
Surgeon fees are computed from the CMS 2026 Physician Fee Schedule relative value file (October release): total relative value units multiplied by the $33.4009 conversion factor, the national average before geographic adjustment. An open SI joint fusion, billed under a separate code, pays the surgeon $1,283.60. Fusion facility rates come from SI-BONE’s 2026 iFuse coding guides, which cite the CMS 2026 final rules. Ablation facility rates come from Boston Scientific’s 2026 radiofrequency ablation reimbursement guide. Both companies sell devices for these procedures.
Adding the two sides, a fusion in a hospital outpatient department comes to about $18,673 ($17,914 plus $759). In a surgery center it is about $15,277 ($14,518 plus $759). An ablation comes to about $2,172 in a hospital outpatient department ($1,995 plus $177) and about $1,126 in a surgery center ($949 plus $177).
In a hospital outpatient department the fusion pays about 8.6 times as much. A listed rate is not coverage, though: in the jurisdictions above, the contractor’s policy says the ablation is not reasonable and necessary.
The fusion criteria are specific. Noridian’s policy requires at least one diagnostic block with at least 75% pain reduction, a trial of at least one therapeutic joint injection giving at least 50% reduction, and imaging of the joint, pelvis and lumbar spine to rule out other causes. Fusion without a transfixing implant is not considered reasonable and necessary.
What the evidence patients read says
Patients find trials of each procedure against something else, and almost nothing comparing the two directly.
Fusion against nonsurgical care. A 2015 trial randomized 148 patients to minimally invasive fusion with titanium implants or nonsurgical management. At six months the success rate was 81.4% against 26.1%, and 73.3% of fusion patients gained a clinically important improvement in disability against 13.6%. (Neurosurgery, 2015) A model built on that trial data put the cost at $13,313 per quality-adjusted life year gained over five years, a measure of years lived in good health. (ClinicoEconomics and Outcomes Research, 2016)
Fusion against sham surgery. A 2024 double-blind trial in Sweden and Norway randomized 63 patients to fusion or a sham operation. Pain on the operated side fell 2.6 points against 1.7, a difference the authors could not prove was real. (EClinicalMedicine, 2024)
Ablation against placebo. In a 2008 trial of 28 patients, 57% of those given ablation had at least 50% relief at six months, and 14% still did at one year. (Anesthesiology, 2008) A 2016 sham-controlled trial of 60 patients found no significant difference in pain between ablation and sham at three months. (Clinical Journal of Pain, 2016)
Ablation against usual care. A 2024 trial randomized 210 patients to cooled ablation or standard medical management. At three months, 52.3% of the ablation group responded against 4.3%. (Regional Anesthesia and Pain Medicine, 2024) A 2024 review rated the overall evidence for ablation Level III, a fair recommendation. (Current Pain and Headache Reports, 2024)
The two side by side. One clinic followed 137 patients for up to six years: 63 kept conservative care, 47 had denervation and 27 had fusion. Fusion patients improved most in pain and disability, and denervation patients sat in between. It was retrospective, and the groups were not randomized. (Neurosurgery, 2018) The claims study found more use of care after fusion: physical therapy in 36.4% against 18.4%, CT scans in 15.4% against 4.9%, and opioid prescriptions in 76.4% against 60.5%. Office visits ran the other way, 86.0% against 90.6%.
Who patients are
Most of these patients are women. In the claims study, 69.8% of the 20,448 patients were female, and the ablation group was older, more likely to have diabetes and had lower family income than the fusion group. In the sham-controlled fusion trial, 94% of patients were women and the mean age was 45.
Noridian’s fusion policy notes that diagnostic blocks and image-guided joint injections are typically used to confirm the SI joint as the source of pain, which is why Medicare’s criteria lean on them.
Some patients reach this question after an earlier lumbar fusion, a group covered in my page on lumbar fusion surgery cost. Others are also weighing a stimulator, covered in my page on spinal cord stimulator cost.
Questions patients ask before they book
These are the questions your page and your front desk need to answer.
- Is the patient’s pain coming from the SI joint at all? A good page explains how the practice confirms it, including the block.
- Will Medicare or the patient’s plan pay for ablation? A good page states the coverage position plainly and what the practice does when it is not covered.
- How long does ablation relief last, and what happens when it wears off? A good page links the follow-up data and explains repeat treatment.
- What will the patient owe for fusion on Medicare, on a commercial plan, or paying cash? A good page answers all three, or says who on staff will.
- How many SI joint fusions does the surgeon do a year? A good page states the surgeon’s own volume.
For related comparisons, my page on disc replacement vs fusion cost shows what patients find for that search.
What a page that wins this search includes
- Both procedures on one page, priced side by side, because no ranking page does that today.
- The Medicare coverage position for each, stated in plain terms with the policy linked.
- A posted cash or bundled price for each, with the facility and surgeon split shown.
- The criteria a patient must meet before fusion, written as the steps the practice follows.
- The evidence linked, including the sham-controlled trials, stated neutrally and left disputed where it is disputed.
If your practice also markets to neurosurgery referrals, my page on neurosurgeon patient acquisition covers that side.
Frequently asked questions
Is SI joint fusion more expensive than radiofrequency ablation? Yes. Medicare’s 2026 national averages put a hospital outpatient fusion at about $18,673 for facility and surgeon together, against about $2,172 for an ablation in the same setting.
Does Medicare cover SI joint radiofrequency ablation? The SI joint policies from WPS, Noridian and CGS state that SI joint denervation, also called radiofrequency ablation, is not considered reasonable and necessary.
Does Medicare cover SI joint fusion? Minimally invasive fusion with an implant that crosses the joint is covered when the patient meets the criteria, including a diagnostic block with at least 75% pain relief. Fusion without a transfixing implant is not covered under Noridian’s policy.
Which works better for SI joint pain, fusion or ablation? No randomized trial has compared them directly. Each has trials showing benefit against usual care, and each has a sham-controlled trial that did not show a clear difference.
Why do cash prices for these procedures vary so much? Setting and implant drive most of it. On MDsave, listed cash prices for SI joint fusion ran from $21,685 to $42,607, and for radiofrequency ablation from $732 to $5,962.
