CMM-405: Spinal Fluoroscopy

Covered: fluoroscopic imaging guidance is allowed only for spinal or paraspinal diagnostic or therapeutic injection procedures when performed with the procedure, when needle/catheter placement cannot be adequately done without image guidance, and when imaging guidance is not already included; fluoroscopy is not medically necessary for non‑spinal/paraspinal indications, when criteria aren’t met, when guidance is already included, or if the patient has contraindications to X‑ray. Key requirements: documentation that the procedure is spinal/paraspinal, clinical rationale that image guidance is required for needle/catheter placement, that guidance isn’t already part of the planned procedure, that any concomitant X‑ray–dependent procedure is documented as the primary procedure, confirmation of no X‑ray contraindications, and appropriate coding (e.g., CPT 77003).

"This guideline only applies to fluoroscopic guidance for spinal or paraspinal (adjacent to the spinal column) diagnostic or therapeutic injection procedures."