CMM-401: Discography

Covered only as a provocative diagnostic test for discogenic axial pain when strict criteria are met; not covered if any red flag is present, if not coincident with a discectomy, if not performed by both the surgeon and a supervising radiologist, or if functional anesthetic discography or nonstandard injectates are used (these are experimental/investigational). Key requirements: absence of red flags, >12 weeks subacute axial pain with ≥6 weeks of failed BOTH NSAIDs/muscle relaxants and conservative self‑care or prescribed PT, imaging evidence of disc damage (e.g., annular tear, contained herniation, HIZ), exclusion of facet and centralized/multicentric pain or fibromyalgia, coordination with the treating surgeon (post‑discography CT auto‑approved), and required documentation including opioid co‑management plan for patients on continuous opioids ≥3 months.

"Post-discography CT scan: automatically approved as an add-on to the discography procedure."