C9809 — Cryoablation needle (e.g., iovera system), including needle/tip and all disposable system components, non-opioid medical device (must be a qualifying medicare non-opioid medical device for post-surgical pain relief in accordance with section 4135 of the caa, 2023)
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Documentation Required
- When billing, providers must use the most appropriate codes as of the effective date of the submission. Claims submitted for services that are not accompanied by covered code(s) under the applicable Coverage Policy will be denied as not covered.
- For trigeminal neuralgia, documentation should support that the condition is refractory to other alternative treatments (e.g., medication, microdecompression) as the policy specifies radiofrequency ablation or glycerol rhizotomy is medically necessary only for trigeminal neuralgia refractory to other treatments.
- No additional explicit step-by-step documentation checklist (e.g., required diagnostic test results or exact prior treatment durations) is provided in the excerpt; reviewers are directed to consider the terms of the applicable benefit plan document, applicable laws/regulations, collateral source materials including Coverage Policies, and the specific facts of each case.
Key Coverage Criteria
- Peripheral nerve destruction using radiofrequency ablation or glycerol rhizotomy is considered medically necessary for treatment of trigeminal neuralgia refractory to other alternative treatments (e.g., medication, microdecompression).
- Considered medically necessary when criteria in the applicable policy statements listed above are met: CPT 61790; CPT 61791; CPT 64600; CPT 64605; CPT 64610.
- Use of neuroablative techniques for the treatment of chronic pain (inferred from policy title: 'Neuroablative Techniques for Chronic Pain').
- No explicit Covered Indications are stated in the provided excerpt.
- Facet Joint Interventions for Pain Management (LCD / LCA)
- Sacroiliac Joint Injections and Procedures
3 Active Policies
CIGNA-0525 — Peripheral Nerve Destruction for Pain Conditions - (0525)
HUMANA-NEUROABLATIVE-TECHNIQUES-FOR-CHRONIC-PAIN-MA — Neuroablative Techniques for Chronic Pain - Medicare Advantage
ANTHEM-SURG.00155 — SURG.00155 Cryosurgery of Peripheral Nerves
Related Codes
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