CMM-208: Radiofrequency Joint Ablations/Denervations

Covered only for facet-mediated spinal pain when other causes are excluded, the patient has failed ≥3 months of conservative therapy (unless contraindicated), and two diagnostic medial branch/facet blocks each produce ≥80% relief for the expected anesthetic duration; repeats allowed ≥6 months after a prior denervation if that prior procedure produced ≥50% relief lasting ≥12 weeks. Key requirements/limits: fluoroscopic guidance is required, treat no more than three contiguous levels per session and no more than two procedures at the same level in 12 months, do not perform for untreated radiculopathy or at posteriorly fused segments (except suspected pseudarthrosis), and pulsed/cooled/endoscopic/cryo/chemical/laser ablations and SI joint ablation are considered investigational or not medically necessary.

"When performed for neck pain or low back pain in the presence of an untreated radiculopathy (considered not medically necessary)."