Automated Percutaneous Discectomy and Percutaneous Endoscopic Discectomy

This policy covers automated percutaneous discectomy and percutaneous endoscopic discectomy—image‑guided percutaneous placement of probes or endoscopic working channels to aspirate/remove herniated intervertebral disc material for patients with symptomatic herniated discs causing neuropathic radiculopathy or sciatica (cervical, thoracic, or lumbar). Major limitations: automated percutaneous discectomy and many percutaneous endoscopic discectomy techniques are designated experimental/investigational and not medically necessary due to insufficient evidence, with automated mechanical lumbar discectomy permitted only under formal research or audit arrangements with documented special consent. Surgery is reserved for true neuropathic nerve‑root irritation after several months of unsuccessful conservative care (not for non‑neuropathic low back pain), although select transforaminal and interlaminar endoscopic lumbar discectomy approaches are supported for sciatica.