CMM-400: Anesthesia Services for Interventional Pain Procedures

MAC is medically necessary only when both the performance and delivery criteria are met; it is covered for specified interventional pain procedures (regional sympathetic block, medial branch RFA, discography, spinal cord stimulator trial/implant, vertebral augmentation, intrathecal drug-delivery implantation) and when risk factors exist (e.g., behavioral-health attestation for severe anxiety, hyperkinetic movement disorders, spinal cord injury, airway anatomic variations, or significant medical comorbidities), and is not medically necessary for spinal manipulation, closed spine procedures, or when criteria are unmet. Key requirements include a preoperative anesthesia evaluation and airway exam, documented informed consent with alternative sedation discussion, continuous capnography, qualified airway-management personnel and supervised recovery by CRNA/anesthesiologist with skilled nursing, documentation of indicated comorbidities/attestations and readiness to convert to general anesthesia; only one anesthesia CPT is allowed per date and MAC is considered only after the interventional procedure is approved (or requires no prior authorization).