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/implant, vertebral augmentation, intrathecal drug delivery implantation) or when patient risk factors exist (behavioral-health attested severe anxiety/cognitive impairment, hyperkinetic movement disorders, airway/anatomic obstruction risk, or significant comorbidities), but MAC for manipulation/closed procedures of the cervical/thoracic/lumbar spine (CPT 00640) is considered experimental/unproven. Coverage requires a preoperative anesthesia evaluation including airway exam, informed consent with alternatives, continual capnography, a qualified airway-management professional present, supervised recovery by skilled staff under CRNA/anesthesiologist oversight, and full supporting documentation; medical necessity is determined case-by-case and after the interventional procedure is approved.

"Documentation that a qualified medical professional was present to recognize and treat airway complications during MAC."