CMM-207: Epidural Adhesiolysis

Epidural adhesiolysis (catheter- or endoscopically performed), including percutaneous lysis with solution or mechanical means and neurolytic epidural/subarachnoid injections, is considered experimental/investigational/unproven and not covered (CPT 62263, 62264, 62280–62282 listed). No covered indications or specific documentation requirements are provided; final reimbursement/authorization determinations are made by the individual health plan.

"None — There are no covered indications listed. The guideline states: 'There is insufficient scientific evidence to support the use of epidural adhesiolysis, performed by catheter or endoscopically..."

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