Ablation of Peripheral Nerves to Treat Pain

This policy addresses percutaneous ablation of peripheral sensory nerves for pain—primarily radiofrequency ablation (including cooled RFA) and percutaneous cryoneurolysis (e.g., iovera)—with coverage linked to facet joint pain (see SUR702.017) and selective use of cooled genicular RFA (COOLIEF) for chronic moderate‑to‑severe knee osteoarthritis. Major limitations require prior conservative therapy, radiographic confirmation of OA (Kellgren‑Lawrence grade 2–4) and ≥50% pain reduction to a diagnostic genicular nerve block for COOLIEF, and many other indications (including RFA/cryoneurolysis for plantar fasciitis, occipital neuralgia/cervicogenic headache, and most other peripheral nerve targets) are considered experimental, investigational, or not addressed.

"Ablation of peripheral nerves for facet joint pain (see medical policy SUR702."

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