This version of the policy will become effective 11/08/2021. The policy has been updated to communicate the company's position regarding interventional spinal pain management services.
The following was added to the policy under the Not Medically Necessary heading:
General anesthesia or MAC is rarely, if ever, required for interventional spinal pain management procedures, including but not limited to nerve blocks. Standard medical practice utilizes local anesthesia or conscious sedation. Administration of medication and monitoring of the patient are performed by the pain management team; the presence of an anesthesiologist/anesthetist is considered not medically necessary.
The Company does not reimburse general anesthesia (01935, 01936, 01991 and 01992) billed in conjunction with interventional spinal pain management procedures because it is considered not medically necessary.
The following procedure codes have been added to the coding table as Not Medically Necessary:
01935, 01936, 01991 and 01992
