CMM-208: Ablations/Denervations of Facet Joints and Peripheral Nerves

RF medial branch/facet joint denervation/ablation is covered for facet‑mediated spinal pain but only using conventional RF (pulsed, cooled, cryo, endoscopic, laser, chemical, basivertebral RF and other listed techniques are considered investigational), and procedures done without fluoroscopic guidance, above C2‑3 or below L5‑S1, in the presence of untreated radiculopathy or posterior fusion (except suspected pseudarthrosis), more than three contiguous levels per session (six if bilateral), same‑day other injections, or exceeding allowed frequency are not medically necessary. Key requirements: pain ≥3 months, ≥4 weeks of failed conservative therapy (unless contraindicated), no other obvious pain generator on exam/imaging, two diagnostic medial branch/facet injections each producing ≥80% relief for initial treatment, documentation of fluoroscopic guidance and levels treated; repeat RF requires ≥50% pain relief for ≥12 weeks and ≥6 months since the prior denervation.