Payer PolicyActive
CMM-308: Intradiscal Procedures
EVICORE-CMM-308-INTRADISCAL-PROCEDURES_FINAL
EviCore by Evernorth
Effective: February 4, 2021
Updated: January 13, 2026
created · Dec 5, 2025
Policy Summary
Intradiscal procedures are considered experimental, investigational, or unproven and are not established as covered indications. The guideline lists CPT codes for informational purposes only, specifies no documentation or test criteria, and states pre-authorization and reimbursement decisions (and any requirements) are determined by each individual payor.
Coverage Criteria Preview
Key requirements from the full policy
"Although the Definitions section describes intended goals/uses (e."
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Covered Medical Codes