Aetna Cryoanalgesia Coverage Update

Coverage and Experimental/Investigational

Aetna considers the following medically necessary or experimental/investigational:

Medically Necessary: The use of cryoanalgesia for the temporary relief of pain due to chronic refractory trigeminal neuralgia (selection criteria in Appendix). Pre-operative, intra-operative, and post-operative cryoanalgesia for post-operative pain management related to the Nuss or Ravitch procedure. Passive cold compression therapy units (e.g., Aircast Cryo/Cuff, Polar Care Cub, Polar Care Packs) and passive hot and cold therapy as medically necessary DME to control swelling, edema, hematoma, hemarthrosis and pain. Note: Mechanical circulating units with pumps have not been proven to be more effective than passive hot and cold therapy.

See Appendix for TN selection criteria.

Experimental/Investigational: Active cold units with mechanical pumps and portable refrigerators with or without compression therapy (e.g., AutoChill, BioCryo, Breg Polar Care Cube, Game Ready, Donjoy IceMan, Ossur Cold Rush, Hilotherm, VPULSE) are considered experimental/investigational. Cryoneurolysis for abdominal pain associated with pancreatic cancer, acute pain, cervicogenic headache, chronic head pain secondary to occipital neuralgia, peripheral neuropathic pain, phantom limb pain, and post-herpetic neuralgia; devices delivering both hot and cold therapy; intra-operative and post-operative cryoanalgesia for post-thoracotomy pain and for reduction of post-tonsillectomy pain; passive cold compression units for indications other than those listed as medically necessary; pre-operative cryoneurolysis for pain management following total knee arthroplasty; prophylactic hypothermia for traumatic brain injury; therapeutic hypothermia for hemorrhagic stroke; therapeutic induction of intra-brain hypothermia (e.g., pro2cool); and ultrasound-guided percutaneous intercostal cryoanalgesia for analgesia following mastectomy are considered experimental/investigational because effectiveness has not been established.

Lists examples and device models.

Cryoanalgesia for pectus excavatum (Nuss/MIRPE)

Evidence and outcomes reported in the literature (informational):

Nuss/pectus repair evidence: Multiple observational studies and randomized trial(s) report that intra-operative intercostal nerve cryoablation during Nuss or minimally invasive pectus repair is associated with decreased length of stay, decreased inpatient opioid consumption, and equivalent pain control compared with thoracic epidural analgesia or PCA; operative time may be increased.

Level of Evidence includes I-II-III across studies

Intra-operative cryoanalgesia for tonsillectomy

Systematic review findings:

Tonsillectomy cryoanalgesia: A systematic review of limited-quality randomized controlled trials (3 trials, 153 participants) reported 21–31% less average post-operative pain with cryoanalgesia versus controls, with no differences in bleeding or time to resume diet; findings are preliminary and require validation by well-designed studies.

Trials used cryotherapy probe or ice-water cooling

Cold therapy units and hot/ice machines

Cold therapy device evidence summary:

Active vs passive cold therapy devices: Active (mechanical pump/refrigerated) and passive cold therapy devices are described in the literature; available studies are of limited quality and have not demonstrated consistent additional benefit of complex active devices over passive devices such as the Cryo/Cuff or conventional ice packs for post-operative outcomes. Aetna's policy is aligned with Medicare DME MAC regarding mechanical cold therapy pumps.

Document cites lack of evidence for superiority of complex active units

Evidence-based indications and limitations

Evidence-summary based stance for specific indications

Tonsillectomy cryoanalgesia: Small randomized trials suggest reduced post-operative pain versus controls but quality is limited and results are preliminary.

See systematic review Raggio et al (2018).

Prophylactic hypothermia for severe TBI: A large randomized trial (POLAR-RCT, n=511) showed no improvement in 6-month neurologic outcomes with early prophylactic hypothermia versus normothermia; does not support routine use.

Cooper et al (2018).

Occipital cryoneurolysis for cervicogenic headache: An RCT (n=52) showed substantial but temporary pain relief that was not significantly different from corticosteroid plus local anesthetic injections; consider only after positive diagnostic blocks and when noninvasive therapies are insufficient.

Kvarstein et al (2019).

Concussion management — investigational/limited evidence

Selective head–neck cooling (concussion) evidence and regulatory status

Head–neck cooling for sports-related concussion: Nonrandomized and small randomized pilot studies report shorter return-to-play times and faster symptom recovery with early selective head–neck cooling; studies are limited by small size, nonrandomized allocation, lack of blinding, and potential bias—evidence is preliminary.

Gard et al (2021), Congeni et al (2022), Al-Husseini (2022).

Device regulatory status: The pro2cool device had received FDA Breakthrough Device designation but was not FDA-cleared at the time of the document; use is considered investigational pending regulatory clearance and robust evidence.

TecTraum/pro2cool status described in document.

Cryoneurolysis for post-operative and cancer pain — preliminary evidence

Percutaneous cryoneurolysis for post-operative and cancer pain

Post-mastectomy cryoneurolysis: Small case series report very low pain scores and no opioid requirement post-operatively; authors recommend randomized trials to validate benefits.

Gabriel et al (2020).

Pectus excavatum (MIRPE) cryoanalgesia: Retrospective series (n=101) reported reduced inpatient opioid use and similar pain scores; concerns about thermal injury noted and larger prospective studies recommended.

Parrado et al (2019).

Splanchnic nerves cryoneurolysis for pancreatic cancer pain: Preliminary case series (n=5) reported marked pain score reduction and decreased analgesic use; randomized trials are needed to validate these findings.

Filippiadis et al (2021).

Trigeminal neuralgia — medically necessary criteria

Selection criteria for cryoanalgesia in trigeminal neuralgia

Trigeminal neuralgia selection: Members have experienced pain for at least 6 months AND have tried and failed pharmacotherapies (e.g., baclofen, carbamazepine, phenytoin) or are unable to tolerate medication side effects.6 months

Repeat cryoanalgesia may be medically necessary every 6 months.

The policy lists several specific indications and device categories as experimental/investigational and therefore not established for routine coverage. Examples include cryo neurolysis for abdominal pain related to pancreatic cancer, peripheral neuropathic pain, phantom limb pain, post-herpetic neuralgia, and intra‑operative or post‑operative cryoanalgesia for post‑thoracotomy or post‑tonsillectomy pain. Also designated investigational are devices that deliver both hot and cold therapy and passive cold compression units for indications other than those explicitly listed as medically necessary.

Available studies do not demonstrate that complex active cold therapy systems with mechanical pumps or refrigeration confer additional clinical benefit compared with simpler passive devices such as the Cryo/Cuff or conventional ice packs. The document states there is no evidence that these more complicated cold therapy units provide any additional benefit over the CryoCuff or conventional ice bags or packs, and notes alignment with Medicare DME MAC policy regarding mechanical cold therapy pumps.

The policy identifies several devices or device families that currently lack adequate evidence of safety and effectiveness or FDA marketing clearance for the listed indications. Examples called out include Kinex ThermoComp and VascuTherm2 (solid‑state continuous cold/compression systems) and other combinations of heating/cooling systems referenced in the scope (e.g., Aqua Relief System, ThermoPlus). Use of such devices for the described pain indications is considered investigational pending stronger evidence or regulatory authorization.

Many of the clinical reports and series cited in the policy have methodological limitations that restrict generalizability. Common limitations include uncontrolled or unblinded designs, small sample sizes, single‑center or retrospective cohorts, and heterogeneity in patient selection and procedural technique. The policy therefore cautions that preliminary positive findings should be interpreted carefully and validated in randomized, adequately powered, and well‑controlled studies before broad adoption.

This Clinical Policy Bulletin is developed to assist in the administration of plan benefits and is not an offer of coverage or medical advice. It provides a general summary of clinical evidence and coverage stance and does not constitute a contract; treating providers retain responsibility for clinical care decisions.

The policy explicitly lists applications of therapeutic hypothermia and intra‑brain cooling that are not supported for routine use, including therapeutic induction of intra‑brain hypothermia (e.g., pro2cool), prophylactic hypothermia for traumatic brain injury, and therapeutic hypothermia for hemorrhagic stroke. These techniques are considered not established for the specified neurologic indications.

Continuous cold therapy systems or Hot/Ice Machines have not been shown consistently to provide superior postoperative outcomes compared with standard cryotherapy (ice packs) or simpler passive units. The policy cites studies that failed to demonstrate consistent benefit and notes that routine use of continuous cold or Hot/Ice Machines for all post‑operative patients is not supported by the available data.

Large randomized evidence does not support early prophylactic hypothermia for severe traumatic brain injury. The POLAR‑RCT (n=511) found no improvement in 6‑month neurologic outcomes with early prophylactic hypothermia compared with normothermia, and therefore early routine prophylactic hypothermia for severe TBI is not recommended.

A double‑blind RCT of occipital cryoneurolysis for cervicogenic headache (n=52) demonstrated substantial but transient pain reductions that were not statistically different from corticosteroid plus local anesthetic injections. The authors concluded occipital cryoneurolysis may be considered only after positive diagnostic blocks and when less invasive therapies have been insufficient, and they raised concerns about potential local scar or neuroma formation with repeated procedures.

CPT, HCPCS, and ICD-10 Codes

Covered CPT CodesCPTCovered

64600	Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch.
64620	Destruction by neurolytic agent, intercostal nerve.

CPT Codes Not Covered / RelatedCPT

0440T	Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve.
0441T	Ablation, percutaneous, cryoablation, includes imaging guidance; lower extremity distal/peripheral nerve.
0442T	Ablation, percutaneous, cryoablation, includes imaging guidance; nerve plexus or other truncal nerve (eg, brachial plexus, pudendal nerve).
0776T	Therapeutic induction of intra-brain hypothermia, including placement of a mechanical temperature-controlled cooling device to the neck over carotids and head, including monitoring (eg, vital signs and sport concussion assessment tool 5 [SCAT5]), 30 minutes of treatment.
64605	Destruction by neurolytic agent, trigeminal nerve; second and third division branches at foramen ovale.
64640	Destruction by neurolytic agent; other peripheral nerve or branch.

Other Related CPT CodesCPT

19301-19307	Mastectomy.
21740-21743	Reconstructive repair of pectus excavatum or carinatum.
27447	Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing.
27486-27487	Revision of total knee arthroplasty, with or without allograft; 1 component (27486) and femoral and entire tibial component (27487).
64400	Injection, anesthetic agent; trigeminal nerve, any division or branch.
64420	Intercostal nerve, single.
64421	Intercostal nerves, multiple, regional block.

HCPCS Codes (DME and related)HCPCS

A9273	Hot water bottle, ice cap or collar, heat and/or cold wrap, any type.
E0217	Water circulating heat pad with pump.
E0218	Water circulating cold pad with pump.
E0236	Pump for water circulating pad.
E0249	Pad for water circulating heat unit.
E0650	Pneumatic compressor; non-segmental home.
E0651	Pneumatic compressor, segmental home model without calibrated gradient pressure.
E0652	Pneumatic compressor, segmental home model with calibrated gradient pressure.
E0671	Segmental gradient pressure pneumatic appliance; full leg.
E0673	Segmental gradient pressure pneumatic appliance, half leg.

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ICD-10 Codes Covered / Not Covered (examples)ICD-10

G50.0	Trigeminal neuralgia.
G54.6	Phantom limb syndrome with pain.
M17.0-M17.9	Osteoarthritis of knee.
R52	Pain, unspecified.

Cryoprobe pressure and device specifics

Cryoprobe operating pressureApproximately 600 pounds per square inch (high-pressure N2O or CO2 delivered through a 12–14 G cryoprobe)

Needle/probe size12- to 14-gauge needle-shaped cryoprobe used to deliver cryogen

Cryogen gasesTypically nitrous oxide or carbon dioxide are used as the high-pressure gas

Authorization, Documentation, and Provider Requirements

Prior Authorization

Prior Authorization Alignment and Guidance

Prior authorization may be required for certain devices or procedures referenced in this policy. Aetna’s approach to mechanical cold therapy pumps is aligned with Medicare DME MAC policy; prior authorization requirements and coverage determinations for these devices will follow that guidance. Prior authorization may also be required for home therapeutic cold devices or novel head–neck cooling systems that lack sufficient evidence or FDA clearance.

Prior authorization follows Medicare DME MAC policy for mechanical cold therapy pumps.
Active cold units with mechanical pumps and combined heat/cold devices may require prior authorization and are generally considered experimental/investigational for many indications.

Prior Authorization

Trigeminal Neuralgia: Selection Criteria and Repeat Interval

For cryoanalgesia to treat trigeminal neuralgia, members must meet selection criteria: symptoms present for at least 6 months and a documented trial of, and failure of, appropriate pharmacotherapies (e.g., carbamazepine, baclofen, phenytoin) or documented intolerance to them. Repeat cryoanalgesia may be considered medically necessary no more often than every 6 months.

Pain duration ≥ 6 months.
Documented trial and failure of, or intolerance to, pharmacotherapies (e.g., carbamazepine, baclofen, phenytoin).
Repeat treatments: minimum 6-month interval between procedures.

Denial Risk

Evidence-Based Coverage Implication for Mechanical Cold Therapy Pumps

Active cold therapy pumps and more complicated circulating units have not been shown to provide added clinical benefit over passive cold compression therapy. As a result, claims for active cold units with mechanical pumps or combined heat/cold systems may be considered experimental/investigational or not covered for many indications.

Mechanical circulating units with pumps lack evidence of superiority to passive hot/cold therapy.
Examples of active/complex systems: IceMan, Game Ready, AutoChill, BioCryo, VPULSE, Hilotherm.

Denial Risk

Evidence and Safety Risks

Use of devices or procedures without adequate clinical evidence or demonstrated safety/effectiveness may be unsupported and subject to denial. Documented clinical rationale, relevant evidence, and justification for use of novel or less-established devices should be provided when seeking coverage.

Devices lacking peer-reviewed evidence of safety/effectiveness carry increased denial risk.
Provide clinical rationale and cite supportive literature when requesting coverage for novel devices.

Denial Risk

Regulatory Status Risk

When a device is not cleared or authorized by the FDA for the requested indication, lack of regulatory clearance increases the risk that coverage will be denied. The pro2cool system (example) was not cleared by the FDA at the time of documentation and lacks market authorization, which should be noted in submissions.

If device is not FDA-cleared for the indication, include rationale and supporting evidence; coverage may be denied.
Example: pro2cool lacked FDA marketing authorization at the time of the referenced documentation.

Note

No Additional Explicit Prior Authorization or Denial Triggers

There are no additional explicit prior authorization requirements or automatic denial triggers specified beyond those described above; determinations will be made based on the clinical indications, evidence, and existing coverage rules.

Absence of an explicit PA requirement in this section does not preclude case-by-case review.
Providers should verify member-specific benefits and PA rules.

Documentation Required

Clinical Documentation and Evidence

Submit comprehensive clinical documentation to support the medical necessity of devices or procedures. Include the clinical rationale, prior conservative therapies tried, diagnostic test results, and citations to relevant peer-reviewed evidence when applicable.

Document clinical rationale and reference supporting evidence or literature.
Include prior conservative treatments and results of diagnostic/test blocks when applicable.

Documentation Required

Required Documentation

Required documentation must be included with requests or claims: device model and manufacturer, indication for use, detailed treatment parameters (e.g., temperature, duration, compression settings), and FDA clearance status when applicable.

Device model and manufacturer.
Indication and clinical rationale.
Treatment parameters (temperature, duration, compression settings).
FDA clearance/authorization status if applicable.

Documentation Required

Required Clinical Documentation

Include the following clinical details in chart notes and prior authorization submissions when relevant: indication (e.g., cervicogenic headache, occipital neuralgia, peripheral neuropathic pain, pre-op for TKA), results of diagnostic or prognostic test blocks, prior treatments and responses, and anticipated benefit.

Clearly state the indication (diagnosis code) and how selection criteria are met.
Provide results of diagnostic blocks or other objective assessments.
List prior therapies and response/tolerance.
Describe expected benefit and treatment plan.

Note

Policy References and Administrative Information

This section of the policy contains references, policy history, and administrative information. Providers should consult the policy history and related policy links for updates and confirm the effective date and next review date when interpreting coverage.

Effective date: 1998-10-13; Next review date listed in policy header.
Review policy history and related CPBs for context and updates.

Step Therapy

Step Therapy Consideration

Step therapy considerations: when evidence is limited for a procedure (e.g., occipital cryoneurolysis), consider requiring less invasive or more established diagnostic/therapeutic steps first (for example, diagnostic nerve blocks or conservative medical management) prior to approving cryoneurolysis.

Recommend diagnostic/test blocks and conservative therapies before approving cryoneurolysis for cervicogenic headache or occipital neuralgia.
Document responses to these prior steps in the medical record.

Clinical Background and Definitions

Active cold compression therapy units that incorporate mechanical pumps or refrigeration (for example, Game Ready, Breg Polar Care Cube, and similar systems) are listed as not covered for the indications described in the policy. The policy also lists devices that deliver both hot and cold therapy and other named systems in the scope as investigational or excluded from routine coverage for the listed pain and postoperative uses.

Cryoanalgesia / Cryoablation — Key facts

DefinitionCryoanalgesia/cryoablation is the delivery of very low temperatures via a probe (using gases such as nitrous oxide or carbon dioxide) to freeze peripheral nerves and produce temporary analgesia.

Typical deliveryHigh-pressure gas administered through a needle-shaped cryoprobe to create focal freezing of nerve tissue

Duration of effectProvides temporary pain relief; effects can be weeks to months depending on application

Common indications notedUsed for refractory trigeminal neuralgia, intercostal nerve ablation during Nuss procedures, and various perioperative applications discussed in literature

Active cold units — Definition and examples

DefinitionActive cold units are mechanical cold therapy systems that use pumps or refrigeration to circulate cooled (or heated) fluid through a wrap, often providing cyclical compression via a pump-controlled system (examples: Game Ready, Breg Polar Care Cube, IceMan).

ComponentsTypically consist of a wrap or pad plus a control unit or pump with a reservoir that circulates chilled water to the wrap

Power sourceMay be battery- or electrically-operated pumps to automate water exchange and compression cycles

Active cold therapy device — Definition/details

DefinitionActive cold therapy device: a device that uses a mechanical or pneumatic pump to circulate cooled or heated fluid through a wrap and may combine intermittent pneumatic compression; examples include Game Ready, IceMan, Hilotherm.

Intended functionProvide cyclical compression and controlled temperature therapy over treatment periods via automated circulation

Typical clinical claimDesigned to maintain consistent cold distribution over large surface areas and remove need for manual water recycling

Passive cold therapy device — Definition/details

DefinitionPassive cold therapy device: a gravity- or hand pump–driven system without electrical power that circulates ice water through a cuff or wrap (examples: AirCast Cryo/Cuff, Polar Care Cub).

MechanismIce water placed in a reservoir cooler elevated above the limb fills the cuff by gravity or via manual pump to provide cold and compression

Clinical roleConsidered medically necessary DME for swelling, edema, hematoma, hemarthrosis, and pain when indicated; simpler than active systems

Cryoanalgesia / Cryoablation — Peripheral nerve application

DefinitionCryoanalgesia/cryoablation of peripheral nerves involves application of extreme cold via a probe to temporarily ablate nerve conduction (e.g., intercostal nerves during Nuss procedures) to reduce post-operative pain.

Clinical effectAssociated in studies with decreased length of stay and reduced inpatient opioid consumption versus alternatives in Nuss procedures

Technique notesThoracoscopic transthoracic and modified probe techniques described to access intercostal nerves during Nuss/MIRPE procedures

Continuous cold/compression device — Definition/details

DefinitionContinuous cold/compression device: solid-state, microprocessor-controlled systems that deliver cold without ice, intermittent compression, and optionally DVT prophylaxis (examples: Polar Care continuous systems, Kinex ThermoComp, VascuTherm2).

FeaturesMicroprocessor-controlled temperatures, pre-programmed therapy cycles (contrast therapy), and automated compression cycles for home use

Evidence noteDocument states lack of robust evidence for safety and effectiveness for some devices; routine superiority over passive therapy not established

Selective head–neck cooling (pro2cool) — Definition/details

DefinitionSelective head–neck cooling (pro2cool) is a portable device applied to the head and neck to cool blood in the carotid arteries and lower brain temperature, proposed for acute concussion management.

Regulatory statusAt time of document the pro2cool system had Breakthrough Device designation but was not FDA-cleared for routine use; considered investigational until clearance and robust evidence are available.

Treatment protocolDescribed as two 30-minute treatments with device-applied cooling over carotids and head, including monitoring (eg, vital signs, SCAT5).

Cryoneurolysis/cryoneurolysis — Definition/details

DefinitionCryoneurolysis (percutaneous) is application of freezing to peripheral nerves to produce a temporary conduction blockade for analgesia; techniques like Iovera provide extended-duration analgesia after a single application.

Clinical findingsRCTs and series report substantial but temporary pain relief for some indications (eg, occipital cryoneurolysis), though differences versus steroid/local anesthetic injections may be non-significant.

Risks and selectionMay be considered after positive diagnostic blocks; repeated procedures carry risks such as local scar or neuroma formation and potential neuropathic pain.

Cryoneurolysis (Iovera) — Definition/details

Iovera (cryoneurolysis technique)Percutaneous technique using exceptionally low temperatures to reversibly ablate a peripheral nerve, producing analgesia lasting weeks to months after a single application.

Use contextDiscussed as an option for extended-duration regional analgesia; limited validation for acute pain and RCTs are needed to define benefits and risks.

Comparison to PNSProduces sensory/motor changes (reversible nerve injury) whereas PNS provides analgesia without inducing sensory or motor deficits.

Percutaneous peripheral nerve stimulation (PNS) — Definition and contrast

DefinitionPercutaneous peripheral nerve stimulation (PNS) involves inserting an insulated lead adjacent to a peripheral nerve to deliver electrical current for analgesia without producing sensory or motor deficits.

Duration and clearancePNS is cleared for up to 60 days of use in some applications; it does not ablate or injure the nerve like cryoneurolysis does.

Contrast with cryo methodsUnlike cryoneurolysis/cryoablation, PNS provides analgesia via neuromodulation and preserves nerve integrity rather than producing reversible axonotmesis.

Cold therapy units — Examples referenced

Common examplesCold therapy units referenced across studies include Cryo/Cuff (AirCast), Polar Care (Breg), Game Ready, IceMan, Hilotherm, VPULSE, and continuous-flow cold therapy units.

Passive examplesAirCast Cryo/Cuff System and Polar Care (PC) Cub Unit are frequently cited passive devices using gravity or hand pump circulation.

Active examplesGame Ready Accelerated Recovery System, IceMan, Hilotherm, and VPULSE are noted active devices that combine pump-driven circulation with compression or heating functions.

Cryoanalgesia / Cryoablation — Additional references

Supplemental definitionCryoanalgesia/cryoablation uses extreme cold via a probe to freeze peripheral nerves for pain control in conditions such as trigeminal neuralgia and post-thoracotomy or intraoperative applications.

MechanismFreezing induces reversible nerve injury that interrupts conduction and provides temporary analgesia with minimal permanent sensory loss reported in many series.

Historical useDescribed in literature for decades for trigeminal neuralgia and other peripheral nerve pain conditions; selection criteria exist for TN applications.

Imaging and Procedural Guidance

Documentation Required

Imaging Guidance for Percutaneous Cryoablation Codes

Imaging guidance is implied or required by CPT descriptions for percutaneous cryoablation codes (0440T–0442T); use imaging as documented in code descriptions when performing percutaneous cryoablation.

Ensure procedural documentation includes the imaging modality used consistent with code descriptors.

Documentation Required

Technical Notes — Intra-operative Cryoanalgesia for Nuss

Intra-operative cryoanalgesia for the Nuss procedure uses thoracoscopic transthoracic or modified probe techniques; providers should follow the procedural methods described in the literature when performing these intra-operative techniques.

Techniques described include probe modification (insulation) to allow ipsilateral nerve ablation and approaches that avoid additional thoracoscopic ports.

Documentation Required

CT Guidance for Splanchnic Nerve Cryoneurolysis

Percutaneous cryoneurolysis of the splanchnic nerves in reported series was performed under CT guidance; document imaging modality when claiming these procedures.

Report use of CT guidance and procedural details (posterolateral paravertebral approach, cryoprobe gauge).

Documentation Required

Ultrasound Guidance for Intercostal Cryoneurolysis

Ultrasound guidance was used for percutaneous intercostal nerve cryoneurolysis in reported mastectomy case reports; document use of ultrasound if applicable.

Include US-guided localization technique and outcomes in procedural documentation.

Documentation Required

Imaging Guidance for Percutaneous Cryoneurolysis

When percutaneous cryoneurolysis is performed in study protocols or for improved accuracy, use and document appropriate imaging guidance (ultrasound or CT) as reported in the literature.

Document imaging modality, localization technique (nerve stimulation/US), and procedural parameters in the record.

Note

Imaging Note — Intraoperative Intercostal Cryoablation

References describing intraoperative intercostal cryoablation techniques for thoracic procedures do not specify imaging requirements in the cited excerpts; follow institution-specific standards and document the approach used.

OpenPayer

Cryoanalgesia and Therapeutic Cold

Coverage Determinations and Evidence Summary

CPT, HCPCS, and ICD-10 Codes

Authorization, Documentation, and Provider Requirements

Clinical Background and Definitions

Prior Treatments and Diagnostic Requirements

Treatment Frequency and Repeat Intervals

Imaging and Procedural Guidance