CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Minimally Invasive Procedures for Back Pain Related to Disc Disease

Defines coverage and noncoverage determinations for various minimally invasive intradiscal and decompression procedures for discogenic low back pain and radiculopathy for Medicare Advantage and Commercial products of Blue Cross Blue Shield Rhode Island.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyMinimally Invasive Procedures for Back Pain Related to Disc Disease

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJan 1, 2023

Next Review DateN/A

Key ActionVerify member benefits and eligibility through the Benefit Booklet or provider call center before submitting claims.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

MultipleProcedures addressed

Not coveredCoverage stance

Specific codesCodes flagged

ReferencedCMS NCD

Coverage determinations

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Not covered / Not medically necessary

Covered when ALL of the following are met:

Noncoverage group: The listed minimally invasive intradiscal procedures (including intraosseous radiofrequency ablation of the basivertebral nerve [Intracept system], annuloplasty or intradiscal biacuplasty, automated percutaneous discectomy, laser discectomy, and radiofrequency coblation/nucleoplasty) are not covered for Medicare Advantage Plans and are considered not medically necessary for Commercial Products due to insufficient evidence of improvement in net health outcomes.

Reflects CMS determination that TTPs are not reasonable and necessary and summarizes randomized trial and systematic review evidence as insufficient or conflicting.

The following services are not covered for Medicare Advantage Plans and are considered not medically necessary for Commercial Products: intraosseous radiofrequency ablation of the basivertebral nerve (Intracept® system) for vertebrogenic back pain; annuloplasty or intradiscal biacuplasty for chronic discogenic back pain; automated percutaneous discectomy as a technique of intervertebral disc decompression for back pain and/or radiculopathy related to disc herniation (lumbar, thoracic, or cervical); and laser discectomy and radiofrequency coblation (disc nucleoplasty) as techniques of disc decompression and treatment of associated pain.

The evidence is insufficient to determine that percutaneous thermal intradiscal procedures and other minimally invasive intradiscal techniques lead to an improvement in net health outcomes. Accordingly, these technologies are considered not medically necessary for Commercial Products and are noncovered for Medicare Advantage Plans.

CPT / HCPCS coding

Covered CPT Codes (listed then designated noncovered when TTPs)CPT

22526

Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level

Not covered / Not medically necessary codes when identified as Percutaneous Thermal Intradiscal Procedures (TTPs)mixedNot Covered

22527	Percutaneous intradiscal electrothermal annuloplasty; unilateral or bilateral including fluoroscopic guidance; one Or more additional levels (List separately in addition to code for primary procedure)
64628	Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral (New code effective 1/01/2022)
62287	Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle-based technique to remove disc material under fluoroscopic imaging Or other form of indirect visualization, with discography and/or epidural injection(s) at the treated level(s), when performed, single Or multiple levels, lumbar
S2348	Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, radiofrequency energy, single Or multiple levels, lumbar using

What providers must do

Prior Authorization

Prior authorization status

Prior authorization is not required for services covered by this policy. Benefits may vary by contract; always verify member-specific requirements before scheduling services.

Note

Benefit & eligibility verification

Verify member benefits and eligibility prior to providing services. Refer to the member’s Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for coverage determinations and any applicable member cost-sharing.

Denial Risk

Denial risk for listed procedures

Claims for the listed minimally invasive intradiscal procedures and related codes may be denied when identified as Percutaneous Thermal Intradiscal Procedures (TTPs) or when considered not medically necessary. Review coding and documentation carefully to support medical necessity.

Affected codes include: 22526, 22527, 64628, 62287, S2348
Services listed as not covered/not medically necessary for Medicare Advantage and Commercial Products may be denied

Documentation Required

Provider billing and member financial responsibility

If services are determined to be not medically necessary or non-covered per the member’s contract, providers may not bill the member unless the member has been informed and agreed in writing in advance to continue treatment at their own expense. For questions about member-specific coverage or to submit comments, contact the provider call center.

Background and scope

Percutaneous thermal intradiscal procedures (TTPs) are minimally invasive techniques in which a catheter or probe is inserted into the intervertebral disc under fluoroscopic guidance to apply thermal or radiofrequency energy to the nucleus, nuclear-annular junction, or annulus. These procedures aim to thermocoagulate tissue, denature collagen, seal annular tears, reduce intradiscal volume, or ablate nociceptive fibers as a means to treat discogenic low back pain or radiculopathy.

Common examples of TTPs and related minimally invasive intradiscal techniques include intradiscal electrothermal annuloplasty (IDET), intradiscal biacuplasty (IDB), radiofrequency coblation (disc nucleoplasty), laser discectomy, and automated percutaneous discectomy. The procedures differ by energy delivery method and probe design—IDET uses a thermal resistive coil catheter heated to high temperatures within the disc, biacuplasty uses paired cooled radiofrequency electrodes to treat a larger annular area, and nucleoplasty or coblation employ radiofrequency energy for decompression.

Definitions of procedures

Percutaneous thermal intradiscal procedures (TTPs) — definition and typical energy/modalities used

DefinitionPercutaneous thermal intradiscal procedures (TTPs) are techniques that insert one or more catheters or probes into the spinal disc under fluoroscopic guidance to apply heat and/or create disruption within the nucleus, nuclear–annular junction, or annulus for coagulation, decompression, sealing annular tears, or destruction of nociceptors to relieve discogenic low back pain.

Typical energy/modalities usedRadiofrequency energy or electrothermal energy delivered via probes or catheters (including resistance coil systems and other delivery technologies).

Placement sitesWithin the nucleus, the nuclear–annular junction, or the annulus (single or multiple probe/catheter approaches).

Commonly identified techniques/devicesIncludes IDET, IDTA, PIRFT, radiofrequency annuloplasty, intradiscal biacuplasty (IDB), radiofrequency coblation (nucleoplasty), and device-specific catheters (e.g., SpineWand, AccuTherm, TransDiscal electrodes).

Primary procedural intentCoagulation or decompression of disc material, sealing annular tears/fissures, or nociceptor destruction to relieve symptomatic annular disruption or contained herniated disc pain.

Intradiscal electrothermal annuloplasty (IDET) — thermal resistive coil catheter technique

DefinitionIntradiscal electrothermal annuloplasty (IDET) involves insertion of a navigable catheter with an embedded thermal resistive coil posterolaterally into the disc annulus or nucleus, with indirect radiofrequency-generated heat applied to the coil to thermocoagulate tissue.

Temperature and durationCoil is heated to approximately 90°C with disc heating for up to 20 minutes.

Proposed advantagesProvides precise temperature feedback and control and can deliver electrothermocoagulation to a broader tissue segment compared with a direct radiofrequency needle.

Alternative/related approachAnnuloplasty has also been described using laser-assisted endoscopic techniques to coagulate disc granulation tissue (percutaneous endoscopic laser annuloplasty).

Intradiscal biacuplasty (IDB) — two cooled RF electrodes technique

DefinitionIntradiscal biacuplasty (IDB) is a technique that uses two cooled radiofrequency electrodes placed on the posterolateral sides of the intervertebral annulus fibrosus to apply radiofrequency energy and treat a larger annular area.

Cooling rationaleProbes are cooled during energy delivery so that a larger treatment area can be achieved than with a standard noncooled radiofrequency needle.

PlacementElectrodes are positioned posterolaterally in the annulus to target nociceptors and annular pain generators.

Relation to other intradiscal RF techniquesContrasts with direct intradiscal radiofrequency thermocoagulation where a probe is placed centrally and activated for a short duration (e.g., 90 seconds at ~70°C); IDB uses dual cooled electrodes to expand treated volume.