CMM-208: Radiofrequency Joint Ablations/Denervations

Radiofrequency joint denervation/ablation is medically necessary only for confirmed facet‑mediated pain when no other cause is identified, conservative therapy has failed for ≥3 months (or is contraindicated), two diagnostic facet/medial branch blocks each give ≥80% relief for the expected anesthetic duration, the procedure uses fluoroscopic guidance, no more than three contiguous levels are treated per session, and repeats are allowed only if prior relief was ≥50% for ≥12 weeks and the repeat is ≥6 months later. Not covered/not medically necessary are procedures without fluoroscopy, on posteriorly fused segments or with untreated radiculopathy, treating >3 contiguous levels in one session or >2 procedures at the same level in 12 months, treating pain above C2‑3 or below L5‑S1, and use of pulsed, cooled, endoscopic, cryo, chemical, laser, or SI‑joint ablation techniques (considered experimental).

"Performance of radiofrequency joint denervation/ablations for ANY of the following indications is considered experimental, investigational, or unproven: Laser ablation."