CMM-208: Radiofrequency Joint Ablations/Denervations

Covered: conventional thermal radiofrequency joint denervation/ablation is medically necessary for facet‑mediated neck or low back pain; excluded/not medically necessary are procedures without fluoroscopic guidance, any treatment with untreated radiculopathy, ablation at fused levels (only above/below fusion allowed), >3 levels per session, repeats <6 months or >2 at same level in 12 months, and pulsed/cooled/cryo/endoscopic/chemical/laser/SI joint ablations which are considered experimental. Key requirements: documented ≥3 months conservative care, two positive diagnostic medial branch/facet blocks (>80% pain relief if local anesthetic alone or ≥50% relief for ≥1 week if anesthetic+steroid), documentation of fluoroscopic guidance and absence of radiculopathy, plus prior ≥50% pain relief lasting ≥12 weeks to qualify for repeat procedures.

"A radiofrequency joint denervation/ablation is considered medically necessary for facet mediated pain resulting from disease, injury or surgery and confirmed by provocative testing when BOTH of the..."