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

Radiofrequency denervation/ablation of facet joints is covered for facet‑mediated pain only when clinical/imaging exclude other causes, pain has persisted ≥3 months, ≥4 weeks of recent conservative therapy has failed (unless contraindicated), and two diagnostic facet/medial branch blocks provide ≥80% relief for the expected anesthetic duration; repeat ablation is allowed if prior relief ≥50% lasted ≥12 weeks and the repeat occurs ≥6 months after the prior procedure. Procedures without fluoroscopic guidance, initial treatments without two positive blocks, repeats lacking the 50%/12‑week/6‑month criteria, treatments with untreated radiculopathy or at posteriorly fused segments (except suspected pseudarthrosis), above C2‑3 or below L5‑S1, >3 contiguous levels, same‑day other injections, atlanto‑occipital/atlanto‑axial ablation, and techniques such as pulsed/cryogenic/cooled/chemical/laser/endoscopic RF, basivertebral or peripheral nerve ablation for non‑facet indications are excluded or considered investigational.