CMM-204: Prolotherapy

Prolotherapy (CPT M0076) is considered experimental, investigational, and unproven for treatment of musculoskeletal pain or instability and is therefore not covered. No specific documentation requirements or prior-authorization criteria are provided in the guideline.

"Based on the lack of conclusive scientific evidence demonstrating the clinical efficacy of prolotherapy combined with the potential to expose individuals to serious adverse side effects or complica..."

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