CMM-208: Radiofrequency Joint Ablations/Denervations

Radiofrequency joint denervation/ablation is medically necessary for facet-mediated neck or low back pain only when other causes are excluded, the patient has failed ≥3 months of conservative therapy (unless contraindicated), and two diagnostic medial branch/facet blocks show ≥80% pain relief for the expected anesthetic duration; fluoroscopic guidance is required and repeat procedures require prior benefit (≥50% relief for ≥12 weeks) and ≥6 months since the prior denervation. Pulsed, cooled, endoscopic, cryo, chemical, laser ablation and SI‑joint ablation are considered experimental/investigational and not covered, and additional limits include no treatment above C2‑3 or below L5‑S1, no >3 contiguous levels per session, and no more than two procedures at the same level within 12 months or any procedure performed without the required diagnostic blocks.

"Pulsed radiofrequency ablation for chronic pain syndromes is considered experimental, investigational, or unproven."