CMM-401: Discography

Diagnostic discography using contrast (± saline) for evaluation of discogenic axial pain is covered when criteria are met, while functional anesthetic discography and use of non‑contrast injectates (e.g., steroids, PRP, stem cells) are experimental/investigational and not covered, and any procedure performed with specified red flags is not medically necessary. Coverage requires documented absence of red flags, ≥6 weeks of conservative care including an NSAID and/or muscle relaxant plus structured self‑care or prescribed PT with less than clinically meaningful improvement, concordant clinical exam and advanced imaging showing disc damage and exclusion of other pain sources, performance by an interventional pain physician or supervising radiologist (with coordination if done with discectomy), documentation of contrast injectate, and additional opioid‑use management documentation for chronic opioid users; post‑discography CT is an approved add‑on.

"Absence of centralized pain syndromes (e."