CMM-207: Epidural Adhesiolysis

EviCore CMM-207 (effective July 1, 2025) states epidural adhesiolysis—catheter-based (caudal, interlaminar, transforaminal) and spinal endoscopic approaches—is experimental/investigational and not a covered treatment for back pain. No specific documentation or medical‑necessity criteria are provided; atypical cases require physician review and possible consultation with the referring clinician/PCP, and inclusion of procedure codes in the table does not imply prior authorization or payment.

"None — no covered indications are stated. (The document states: "There is insufficient scientific evidence to support the use of epidural adhesiolysis, performed by catheter or endoscopically, as a..."

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