SURG.00072 Lysis of Epidural Adhesions

This policy addresses lysis of epidural adhesions (epidural neurolysis), including techniques such as hypertonic saline injection, mechanical catheter manipulation, hyaluronidase, balloon dilation, or radiofrequency ablation, with or without steroids or analgesics. Anthem considers all forms of epidural adhesiolysis investigational and not medically necessary; therefore, it is not covered. This noncoverage applies regardless of indication (e.g., failed back syndrome, epidural fibrosis/adhesive arachnoiditis), technique, or adjuncts; related codes include 62263, 62264, 62281, and 62282.

"Lysis of epidural adhesions by any means, including but not limited to, use of hypertonic saline injections, mechanical catheter manipulation, hyaluronidase, whether done with or without steroids o..."

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