Addendum to Musculoskeletal Management Guidelines

The addendum states that MAC, discography, greater occipital nerve blocks, neurolytic lesioning, epidurography, spinal fluoroscopy and ankle/subtalar arthroscopy are medically necessary only when strict, procedure‑specific criteria are met and excludes numerous experimental/unproven uses (e.g., occipital nerve ablation, chemonucleolysis, anesthesia for spinal manipulation, epidurography for needle‑placement mapping, separate fluoroscopy billing when included). Required documentation includes specific clinical findings, prior conservative therapy failure, appropriate imaging and procedural guidance (fluoroscopy/CT/MRI as applicable), a comprehensive headache evaluation for occipital blocks, co‑management and an opioid‑safety plan for chronic opioid users, and for MAC a covered planned deep‑needle procedure plus justification and readiness to convert to general anesthesia.

"CMM-400 Monitored anesthesia care (MAC) for diagnostic or therapeutic nerve blocks, injections, and percutaneous pain management is considered medically necessary when performed with a covered deep..."