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Pain Management and Pain Rehabilitation

Coverage Summary pain Management and pain Rehabilitation Policy Number: P-007 Products: UnitedHealthcare Medicare Advantage Plans Original Approval Date: 07/16/2008. Approved by: UnitedHealthcare Medicare Benefit Interpretation Committee Last Review Date: 09/15/2020. Related Medicare Advantage Policy Guidelines: Assessing Patient's Suitability for Electrical Nerve Prolotherapy, Joint Sclerotherapy, and Ligamentous Stimulation Therapy (NCD ) Injections with Sclerosing Agents (NCD ). Paravertebral Facet Joint Injections This information is being distributed to you for personal reference. The information belongs to UnitedHealthcare and unauthorized copying, use, and distribution are prohibited.

Page 3 of 11 UHC MA Coverage Summary: Pain Management and Pain Rehabilitation Proprietary Information of UnitedHealthcare. Copyright 2019 United HealthCare Services, Inc.

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  Rehabilitation, Management, Pain, Pain management and pain rehabilitation

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