CMM-208: Ablations/Denervations of Facet Joints and Peripheral Nerves

Covered: Radiofrequency denervation/ablation of facet joints (C2-3 to L5-S1) is medically necessary for facet-mediated axial cervical, thoracic, or lumbar pain only when pain ≥3 months, ≥4 weeks of conservative therapy in the past 3 months (or documented contraindication), imaging/clinical evaluation excludes other causes, there are two sequential diagnostic medial branch/facet injections at the same level(s) each producing ≥80% relief for the expected anesthetic duration, the procedure is performed under CT/fluoroscopy at an unfused posterior motion segment (exception for suspected pseudarthrosis), and limits apply (≤3 contiguous levels per session [≤6 if bilateral], ≤2 procedures per level per 12 months, ≥6 months between repeat procedures, repeat allowed only if prior gave ≥50% relief for ≥12 weeks). Excluded: pulsed, cooled, endoscopic, cryo, chemical, laser, basivertebral nerve RF and specified peripheral nerve ablations (e.g., for chronic pain syndromes, foot/heel, hip, knee, SI joint, shoulder) are considered experimental/investigational and not covered; only one invasive modality is allowed per date of service.