Lysis of Epidural Adhesions

This policy addresses lysis of epidural adhesions (e.g., percutaneous adhesiolysis/Racz procedure and related epiduroscopy/endoscopic techniques) to mechanically disrupt epidural scar tissue and deliver therapeutic agents for patients with epidural fibrosis, adhesive arachnoiditis, post‑surgical/failed back surgery syndrome, radicular or chronic low back pain and central lumbar spinal stenosis. Coverage is subject to the member’s specific benefit plan, and many catheter‑based and endoscopic epidurolysis techniques (including mechanical catheter disruption and hypertonic solution injections) are deemed experimental/investigational and not covered due to limited, heterogeneous, and mostly short‑term evidence with weak overall recommendations.

"Offered as a component of a multimodality pain management program for patients with epidural adhesions."

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