CMM-401: Discography

Discography is medically necessary only as a provocative diagnostic test for axial neck/back pain when red-flag conditions, centralized pain/fibromyalgia, or other pain sources (radicular, trigger points, sacroiliac, or unruled-out facet disease) are absent; functional anesthetic discography is investigational and chemonucleolysis is not separately covered. Key requirements are documentation of ≥6 weeks failed conservative care (NSAIDs and/or muscle relaxants plus self-care or prescribed PT), imaging evidence of disc damage (annular tear, contained herniation, or high-intensity zone), coordination with the surgeon and supervising radiologist (and coincidence with planned discectomy when applicable), documentation of absence of red flags, opioid co-management/overuse plan if on continuous opioids ≥3 months, and post-discography CT is an approved add-on.

"A diagnostic discography is considered medically necessary when it is an authorized benefit coverage for a planned discography."