Payer PolicyActive
CMM-308: Thermal Intradiscal Procedures
EVICORE-MSK_ADVANCED-0210DFD8
EviCore by Evernorth
Effective: August 11, 2017
Updated: January 13, 2026
created · Dec 5, 2025
Policy Summary
Thermal intradiscal procedures (IDET, IDTA, PIRFT, RA, and PDD/Coblation nucleoplasty) are considered not medically necessary/excluded due to insufficient evidence of efficacy and potential for serious adverse events. No covered indications or documentation requirements are provided; CPT codes are listed for informational purposes only and prior authorization/reimbursement decisions are determined by individual payors.
Coverage Criteria Preview
Key requirements from the full policy
"None — The guideline states that these procedures are considered not medically necessary and does not list any covered indications."
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