CMM-400: Anesthesia Services for Interventional Pain Procedures

Monitored anesthesia care (MAC) is covered only when used for specified interventional pain procedures (regional sympathetic blocks; medial branch RFA; discography; spinal cord stimulator trial/permanent implant; vertebral augmentation; intrathecal drug delivery system implantation) or for listed high‑risk patient conditions, whereas MAC for spine manipulation/closed spine procedures and CPT 00640 (sitting cervical spine procedures) is considered experimental/investigational. Coverage requires case‑by‑case medical necessity and documentation of the indication plus all delivery requirements — preop anesthesia evaluation and informed consent, continual capnography (with pulse oximetry), qualified anesthesia personnel and airway management, supervised recovery by skilled staff, and only one anesthesia CPT allowed per date (MAC considered only after the primary procedure is approved).

"MAC will be used during ANY of the following interventional pain procedures: Regional sympathetic blocks"