CMM-208: Ablations/Denervations of Facet Joints and Peripheral Nerves

Thermal radiofrequency (CT/fluoroscopic-guided) medial branch/facet joint denervation/ablation is covered as medically necessary for facet‑mediated axial cervical, thoracic, or lumbar pain when all criteria are met: ≥3 months of pain, ≥4 weeks recent conservative therapy (or documented contraindication), two sequential diagnostic facet/medial branch blocks at the same levels with ≥80% relief for the expected anesthetic duration, imaging excludes other causes, no untreated radiculopathy, and procedure performed at unfused posterior motion segment(s) (exception for suspected pseudoarthrosis); repeat procedures require ≥6 months interval and prior relief ≥50% lasting ≥12 weeks. Limits: up to three contiguous levels per session, no more than two procedures per level in a rolling 12 months, only thermal RF under CT/fluoro is allowed, and pulsed/cooled/cry0/chemical/laser/endoscopic techniques, basivertebral and SI‑nerve ablation, and peripheral nerve destruction for the listed non‑spinal conditions are considered not medically necessary or investigational.