About this policy
CMS National Coverage Determination | ncd_id=19 | manual_section=160.1 | coverage_level_code=2 | national_coverage_type=True | under_review=False | lab_ncd=False
Coverage indications
Surgically induced lesions of nerve tracts which involve destruction of nerve tissue are primarily indicated for controlling the chronic or acute pain arising from conditions such as terminal cancer or lumbar degenerative arthritis. Induced lesions of nerve tracts may be produced by surgical cutting of the nerve (rhizolysis), chemical destruction of the nerve, or by creation of a radio-frequency lesion (electrocautery). Accordingly, program payment may be made for these denervation procedures when used in selected cases (concurred in by the Medicare Administrative Contractorâs medical staff) to treat chronic pain. Note that these procedures differ from those employing implanted electrodes and associated equipment to control pain in that the nerve fibers are ablated rather than stimulated and no electronic equipment is required by the patient after the operation.
Documentation requirements
Benefit Categories: 52 - Physicians' Services
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
Backwork has no codes on record for this policy. Check the source.