Documentation and Medical Necessity - Ablative Treatment for Spinal Pain - UHC Medical Policy

by  Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
September 21st, 2015

According to UnitedHealthcares policy: For chronic cervical, thoracic and lumbar pain, Thermal radiofrequency ablation of facet joint nerves is proven and medically necessary when confirmed by the following:

UHC policy also states, Thermal radiofrequency ablation is proven and medically necessary:

and is unproven and not medically necessary:

The policy states "Ablation procedures performed more frequently than every 6 months increase the risk of adverse events without improving the clinical outcome".

Required documentation for the above procedures must include:

Thermal radiofrequency ablation is considered unproven and not medically necessary for the treatment of all other causes of spinal pain including but not limited to the following:

 Coding Clarification CPT codes 646336463464635, and 64636 only apply to thermal radiofrequency ablation. CPT code 64999 is to be used for pulsed radiofrequency ablation.

Read the entire Policy here

References:

Documentation and Medical Necessity - Ablative Treatment for Spinal Pain - UHC Medical Policy. (2015, September 21). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/documentation-and-medical-necessity-ablative-treatment-for-spinal-pain-uhc-medical-policy-31632.html

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