CMM-207: Epidural Adhesiolysis

Epidural adhesiolysis (catheter-based or endoscopic, via caudal, interlaminar, or transforaminal approaches) is considered experimental, investigational, or unproven for treatment of back pain and therefore not a covered indication; CPT codes 62263, 62264, 62280–62282 are listed as experimental/investigational. No documentation or coverage requirements are specified in the guideline, and final reimbursement decisions remain subject to individual health plan benefits and claims processing (inclusion of codes does not necessarily indicate prior authorization is required).

"None — There are NO covered indications listed. The guideline states: "There is insufficient scientific evidence to support the use of epidural adhesiolysis, performed by catheter or endoscopically..."

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