Addendum to eviCore Guidelines

This Evicore addendum defines medical necessity criteria for discography (with automatic post‑discography CT approval), greater occipital nerve blocks, neurolytic lesioning, epidurography, spinal fluoroscopy, and ankle/subtalar arthroscopy, and excludes functional anesthetic discography, occipital nerve ablation, neurolysis without fluoroscopic/CT guidance, certain non‑surgical or unsupervised discographies, excessive/too‑frequent occipital blocks, and procedures contraindicated by infection, red flags, or unsafe comorbidity. Key requirements include documented absence of red flags, procedure‑specific documentation (e.g., ≥6 weeks of specified conservative therapy and supportive imaging/exam for discography; comprehensive headache evaluation and documented benefit/self‑care attempts for occipital blocks; MRI and prior adequate pharmacotherapy plus imaging guidance for neurolytic lesions; and formal radiologic reporting for epidurography).

"A diagnostic discography is considered not medically necessary when not performed by both the surgeon and a supervising radiologist."