Neuralgia Inducing Cavitational Osteonecrosis (NICO)

This policy addresses diagnosis and management of suspected Neuralgia Inducing Cavitational Osteonecrosis (NICO), including consideration of tooth extraction with periapical curettage to relieve chronic pain after endodontic treatment and related conditions such as odontalgia and myofascial pain. However, NICO diagnosis and most treatments (including cavitation removal, decortication/curettage, Cavitat ultrasonography, bone grafting, chelation, IV vitamin C, and other therapies) are considered experimental/investigational or not medically necessary; surgical intervention is not supported without confirmation by an orofacial pain specialist and coverage is subject to the member’s benefit contract.

"Tooth extraction followed by periapical curettage may be offered to attempt to alleviate chronic pain associated with previously endodontically treated teeth."

Sign up to see full coverage criteria, indications, and limitations.