CMM-401: Discography

Lumbar discography is covered only as a provocative diagnostic test when strict criteria are met: absence of red flags, failure of ≥6 weeks conservative therapy (NSAID/muscle relaxant plus self‑care or PT), subacute axial pain >12 weeks with exam consistent with disc disease (worse upright, no radiculopathy/trigger points/SI dysfunction), advanced imaging that rules out other causes and shows disc damage (annular tear, contained herniation, HIZ), absence of centralized pain, performed with contrast (±saline) by an interventional pain physician or supervising radiologist (post‑discography CT is an approved add‑on). Cervical and thoracic discography, use of non‑contrast injectates, and functional anesthetic discography are not covered (the latter experimental/investigational), and discography results alone cannot determine medical necessity for subsequent procedures.

"A post-discography CT scan is automatically approved as an add-on"