Pulsed Radiofrequency for the Treatment of Chronic Pain
Defines Blue Cross Blue Shield - Rhode Island coverage stance for pulsed radiofrequency (RF) denervation to treat chronic spinal/back pain (facet-related), including coding guidance and relation to commercial and Medicare Advantage products.
Policy last updated 01/12/2021; published in multiple provider updates (2017-2021).
Coverage Summary
This policy covers Pulsed radiofrequency denervation for chronic spinal/back (facet-related) pain. The policy scope defines Blue Cross Blue Shield - Rhode Island's coverage stance for pulsed RF denervation for chronic spinal/back pain for both Commercial & Medicare Advantage product lines. The high-level coverage stance is not covered / not medically necessary for treatment of chronic spinal/back pain because the evidence is insufficient to determine effects on health outcomes. The policy effective date is 2018-02-19 and the last review date is 2021-01-12. For member-specific benefits and any contract variations, refer to the applicable Benefit Booklet / Evidence of Coverage / Subscriber Agreement.
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