CMM-207: Epidural Adhesiolysis

Epidural adhesiolysis (catheter or endoscopic) for back pain is considered experimental, investigational, or unproven and is not supported as a covered indication in this policy. CPT codes are informational only (inclusion does not imply coverage or prior authorization); actual coverage, documentation needs, and prior‑authorization requirements are determined by the member’s specific benefit plan and applicable laws/regulations.

"None identified. The policy states there is insufficient scientific evidence to support the use of epidural adhesiolysis (performed by catheter or endoscopically) as a treatment for back pain."

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