Ablative Treatment for Spinal Pain - UHCprovider.com

Ablative Treatment for Spinal pain Page 1 of 15 UnitedHealthcare Commercial Medical Policy Effective 01/01/2022 Proprietary Information of UnitedHealthcare. Copyright 2022 United HealthCare Services, Inc. UnitedHealthcare Commercial Medica l Policy Ablative Treatment for Spinal pain Policy Number: 2022T0107Z Effective Date: January 1, 2022 Instructions for Use Table of Contents Page Coverage Rationale .. 1 Documentation Requirements .. 2 Definitions .. 2 Applicable Codes .. 3 Description of Services .. 4 Clinical Evidence .. 4 Food and Drug Administration .. 12 References .. 12 Policy History/Revision Information .. 14 Instructions for Use .. 14 Coverage Rationale Thermal Radiofrequency Ablation of facet joint nerves is proven and medically necessary for the following: Initial Treatment of chronic cervical (C3-4 joint and below), thoracic and lumbar pain when: o Clinical documentation shows a Functional Impairment due to facet pain ; and o Clinical documentation of a diagnostic Facet Joint Injection a

Complex Regional Pain Syndrome (CRPS): A . Chronic Pain. condition that affects a limb (arm, hand, leg or foot) usually after an injury to a nerve. CRPS is divided into two types: CRPS-I and CRPS-II. Individuals without a confirmed nerve injury are classified as having CRPS-I (previously known as reflex sympathetic dystrophy syndrome). CRPS-II ...

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  Treatment, Syndrome, Regional, Complex, Spinal, Pain, Reflex, Ablative, Dystrophy, Complex regional pain syndrome, Crps, Sympathetic, Ablative treatment for spinal pain, Reflex sympathetic dystrophy syndrome

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