CMM-400: Anesthesia Services for Interventional Pain Procedures

MAC is medically necessary for specified interventional pain procedures (e.g., regional sympathetic blocks, medial branch RFA, discography, spinal cord stimulator trial/implant, vertebral augmentation, intrathecal pump implantation) or for patients with severe anxiety (behavioral health attestation), hyperkinetic movement disorders, airway-anatomic risks, or significant comorbidities; MAC for manipulation/closed spine procedures (CPT 00640) is experimental/unproven and not covered. Coverage requires a prior case-specific medical-necessity determination and documentation plus a preoperative anesthesia evaluation, informed consent (alternatives discussed), continuous capnography/pulse oximetry, qualified airway-management personnel present, supervised recovery under CRNA/anesthesiologist oversight, and payor-specific requirements must be followed.

"Monitored anesthesia care (MAC) is considered medically necessary when MAC will be used during any of the following interventional pain procedures: Regional sympathetic blocks"