CMM-207: Epidural Adhesiolysis

Epidural adhesiolysis (catheter-based or endoscopic, including caudal, interlaminar, transforaminal, or spinal endoscopy approaches) is considered experimental, investigational, and unproven for treating back pain and therefore not covered; CPT codes 62263, 62264, 62280, 62281, and 62282 are listed as EIU. The guideline cites insufficient scientific evidence, specifies no approved indications or documentation requirements, and notes that final reimbursement/prior-authorization decisions are determined by the health plan and claims rules.

"None — epidural adhesiolysis (performed by catheter or endoscopically) as a treatment for back pain is considered experimental, investigational or unproven (EIU)."

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