CMM-208: Ablations/Denervation's of Facet Joints and Peripheral Nerves

Cigna/EviCore covers CT- or fluoroscopy‑guided radiofrequency denervation/ablation of facet joints (C2-3 to L5‑S1) for facet‑mediated cervical, thoracic, or lumbar axial pain but deems pulsed/cooled RF, cryoablation, chemical/laser/endoscopic techniques, basivertebral and sacroiliac nerve ablations, and indications like third occipital nerve ablation for headaches not medically necessary or experimental. Coverage requires ≥3 months of pain, ≥4 weeks of recent conservative therapy (or documented contraindication), two sequential diagnostic facet/medial branch blocks with ≥80% relief for the expected anesthetic duration, exclusion of other causes on exam/imaging, unfused posterior motion segments (pseudoarthrosis exception), limits of ≤3 contiguous levels per side (≤6 if bilateral), no more than two procedures per 12 months with ≥6 months between, repeat procedures require prior relief ≥50% lasting ≥12 weeks, and full supporting documentation.

"A radiofrequency joint denervation/ablation is considered medically necessary for facet-mediated cervical, thoracic, or lumbar axial pain resulting from disease, injury, or surgery when ALL of the ..."