CMM-208: Radiofrequency Joint Ablations/Denervations

Covered only for facet‑mediated spinal pain; excluded or considered not medically necessary/experimental for other indications (e.g., SI‑joint ablation, third occipital nerve for headaches), and for pulsed, cooled, endoscopic, cryo, chemical, laser techniques or procedures without fluoroscopic guidance, ablation above C2‑3 or below L5‑S1, >3 levels/session, >2 procedures at same level in 12 months, or same‑day other injections. Key requirements: pain worsened by facet‑loading maneuvers, imaging excludes other causes, ≥3 months conservative therapy (unless contraindicated), two sequential diagnostic medial branch/facet blocks each with ≥80% relief, fluoroscopic/CT guidance, and repeat denervation only after ≥50% relief lasting ≥12 weeks and ≥6 months since prior procedure.

"Ablation by any method for sacroiliac (SI) joint pain (refer to CMM-203: Sacroiliac Joint Procedures)."