CMM-400: Anesthesia Services for Interventional Pain Procedures

MAC is medically necessary for specified interventional pain procedures (regional sympathetic blocks, medial branch RFA, discography, spinal cord stimulator trial/implantation, vertebral augmentation, intrathecal drug delivery implantation) or when certain risk factors exist (behaviorally‑attested severe anxiety/cognitive/psychiatric impairment, hyperkinetic movement disorders, airway‑risk anatomic abnormalities, or significant comorbidities such as active hepatitis, cardiac disease, ESRD on dialysis, morbid obesity, or severe pulmonary disease). Coverage requires preoperative anesthesia evaluation, informed consent, continuous capnography plus a qualified airway‑management professional, and supervised recovery by CRNA/anesthesiologist; MAC is not medically necessary if these requirements aren’t met, and MAC for spine manipulation/closed spinal procedures (and CPT 00640) is considered experimental/investigational.

"There is a presence of ANY of the following: Hyperkinetic movement disorders including any of the following: Basal ganglia disease"