CMM-208: Radiofrequency Joint Ablations/Denervations

Radiofrequency joint denervation/ablation is medically necessary for facet‑mediated neck or low‑back pain only when clinical/imaging excludes other causes, ≥3 months of conservative therapy has failed (or a documented contraindication exists), and two diagnostic medial branch/facet blocks produce ≥80% relief (repeat denervation allowed only after prior ≥50% relief lasting ≥12 weeks and ≥6 months since the prior procedure). Procedures must be fluoroscopically guided, limited to C2‑3 through L5‑S1 and no more than three levels per session (bilateral allowed), no treatment of posteriorly fused segments or untreated radiculopathy, no more than two procedures at the same level within 12 months, and pulsed/cooled/cryogenic/endoscopic/chemical/laser ablation and sacroiliac joint ablation are considered experimental/unproven and excluded.

"A radiofrequency joint denervation/ablation is considered medically necessary for facet mediated pain resulting from disease, injury or surgery when ALL of the following criteria are met: Clinical ..."