S2348 — Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, using radiofrequency energy, single or multiple levels, lumbar
HCPCS/CPT
Prior Authorization
No Prior Auth Required
No active coverage policies found for this code (low confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Member-specific benefit plan document must be referenced when deciding coverage; 'When deciding coverage, the member specific benefit plan document must be referenced as the terms of the member specific benefit plan may differ from the standard plan.' (Instructions for Use)
- Informational (FDA PMA language): For Barricaid® (PMA), indication requires confirmation 'by history, physical examination and imaging studies which demonstrate neural compression using MRI' and that the device is used 'to treat a large annular defect (between 4-6 mm tall and between 6-10 mm wide) following a primary discectomy procedure at a single level between L4 and S1.' (U.S. Food and Drug Administration section)
- Applicable codes and coding lists are provided for reference only and do not establish coverage; documentation should support medical necessity per the member's benefit plan and any applicable federal/state mandates. (Applicable Codes / Instructions for Use)
Key Coverage Criteria
- None — this Medical Policy states the following procedures are unproven and not medically necessary due to insufficient evidence of efficacy: Annular closure devices (ACDs); Percutaneous injection of allogeneic cellular/tissue-based products; Thermal intradiscal procedures (TIPs) for treating discogenic pain. (Coverage Rationale)
- Note (informational, not a payer coverage determination): FDA premarket approval (PMA) for the Barricaid® Annular Closure Device is described in the document: 'indicated for reducing the incidence of reherniation and reoperation in skeletally mature patients with radiculopathy (with or without back pain) attributed to a posterior or posterolateral herniation, and confirmed by history, physical examination and imaging studies which demonstrate neural compression using MRI to treat a large annular [...]
- Intraoperative EMG monitoring of the facial nerve during surgery for cholesteatoma, including mastoidotomy or mastoidectomy
- ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "H93.3x1 - H93.3x9" Disorders of acoustic nerve [compression].
- ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "I06.0 - I06.9" Diseases of aortic valve.
- ICD-10 codes covered if selection criteria are met for intraoperative SEPs (as listed): "I35.0 - I35.9" Nonrheumatic aortic valve disorders.
13 Active Policies
AMBETTER-CP.MP.114 — Disc Decompression Procedures
UHC-POL-discogenic-pain-treatment — Discogenic Pain Treatment
AETNA-CPB-0602 — Intradiscal Procedures
AETNA-CPB-0697 — Intraoperative Neurophysiological Monitoring
ANTHEM-SURG.00071 — SURG.00071 Percutaneous Spinal Surgery
Related Codes
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