CurrentCapital BluecrossPolicy MP 6.027

Lysis of Epidural Adhesions

Defines Capital BlueCross coverage stance for catheter-based and endoscopic techniques to lyse epidural adhesions (Racz procedure and variants) for members under applicable products; affects providers requesting coverage for these procedures.

Policy Summary

PayerCapital Bluecross

PolicyLysis of Epidural Adhesions

Policy CodePolicy MP 6.027

Change TypeNo material change

Effective DateFeb 1, 2026

Next Review Date

Key ActionVerify member benefits and obtain benefit verification prior to scheduling investigational procedures coded 62263 or 62264.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not coveredcoverage stance

2procedure codes listed

02/01/2026effective date

Insufficientevidence

Capital BCpayer scope

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 Medically Necessary / Investigational

Covered when ALL of the following are met:

Investigational stance: Catheter-based or endoscopic techniques for lysis of epidural adhesions (mechanical disruption with a catheter and/or injection of hypertonic solutions with corticosteroids, analgesics, or hyaluronidase) are considered investigational due to insufficient evidence of health outcomes benefit.

Several randomized controlled trials exist but are limited by heterogeneous protocols, populations, and potential placebo effects; evidence judged insufficient.

Catheter-based and endoscopic techniques for lysis of epidural adhesions are considered investigational and are excluded from coverage due to insufficient evidence demonstrating benefit. Techniques described include mechanical disruption with a catheter and/or injection of hypertonic solutions with corticosteroids, analgesics, or hyaluronidase. (These services are listed as investigational and therefore not covered in the coding section.)

No explicit additional exclusions are stated in the policy history or related administrative sections of this document.

Percutaneous or endoscopic lysis of epidural adhesions is considered investigational and therefore is not medically necessary / not covered. This applies to catheter-based adhesiolysis procedures whether performed percutaneously or with endoscopic guidance.

The provided policy history and administrative content do not list any explicit conditions or scenarios described as 'not medically necessary' beyond the investigational stance already stated.

Provider Requirements and Billing Impact

Denial Risk

Actionable billing and coverage notes

Procedures coded with CPT 62263 or 62264 and other catheter‑based techniques for lysis of epidural adhesions are considered investigational and are not covered under Capital Blue Cross medical policies. Providers must verify member benefits and eligibility prior to scheduling services, as coverage may vary by product or program. This policy applies to health care benefit programs issued or administered by Capital Blue Cross and its subsidiaries; providers should follow the member's contract and benefit terms when submitting claims.

Investigational codes: CPT 62263, CPT 62264 (and related catheter-based adhesiolysis codes) — investigational and not covered; obtain benefit verification prior to scheduling.
Investigational procedure — denial risk: Procedures for lysis of epidural adhesions are investigational and therefore not covered; claims billed with the listed procedure codes may be denied.
No explicit additional denial triggers are specified in the policy text beyond investigational (not covered) status; follow member benefit terms for adjudication.
Policy applicability: Applies to health care benefit programs issued or administered by Capital Blue Cross and its subsidiaries; coverage may vary by product (see Product Variations).
Provider action: Verify member benefits, eligibility, and prior authorization requirements (if any) with Capital Blue Cross before performing or billing for these services.

Clinical Background

Epidural fibrosis and adhesive arachnoiditis frequently occur after spinal surgery and can entrap nerve roots, producing chronic burning low back pain, radicular symptoms, and neurologic deficits. Lysis of epidural adhesions (sometimes called the Racz procedure) uses a catheter to mechanically disrupt scar tissue and may include injections of hypertonic saline, corticosteroids, analgesics, or hyaluronidase; approaches vary and may be performed percutaneously or endoscopically. Evidence from randomized trials is heterogeneous and insufficient to establish that these interventions improve health outcomes.

Key Terms

ADHESION

DefinitionA band of scar tissue that binds anatomic surfaces that normally are separate from each other.

Related contextCommonly occurs after spinal surgery and can contribute to nerve root entrapment and chronic radicular pain (see Treatment/Racz procedure).

Clinical implicationMay be targeted by adhesiolysis procedures intended to mechanically disrupt scar tissue and restore epidural space patency.

ARACHNOIDITIS

DefinitionInflammation of the arachnoid membrane that covers the brain and spinal cord (also called arachnitis).

Anatomic noteInvolves the arachnoid membrane located between the pia mater and dura mater.

Clinical relevanceCan be associated with chronic pain syndromes involving the spinal cord and nerve roots.

EPIDURAL

DefinitionThe space outside or above the dura mater of the brain and spinal cord.

Procedural relevanceEpidural space is the target for catheter placement and injectates during epidural adhesiolysis procedures.

ImagingEpidurography (fluoroscopy) is commonly used to confirm epidural catheter placement and identify nonfilling adhesions.

FIBROSIS

DefinitionProliferation of fibrous connective tissue; scar formation.

PathophysiologyOccurs as part of normal scar formation after injury or surgery and can lead to symptomatic nerve entrapment (epidural fibrosis).

Treatment targetFibrotic tissue may be the focus of mechanical disruption during adhesiolysis procedures.

lysis of epidural adhesions

DefinitionTherapeutic endoscopic division of epidural adhesions.

Synonyms/ProceduresAlso referred to as endoscopic epidurolysis or components of the Racz procedure when performed under endoscopic visualization.

Technique noteMay be performed endoscopically or percutaneously; endoscopic approaches use direct visualization while percutaneous approaches typically use fluoroscopic epidurography.

Frequency and Repeat Procedure Limits

Lysis of epidural adhesions (fluoroscopic guidance)

Procedure guidanceLysis of epidural adhesions as described in this policy is commonly performed with fluoroscopic guidance (epidurography) to guide catheter placement.

Technique detailsProcedure involves passage of a fluoroscopically guided catheter (Racz catheter) inserted endoscopically or percutaneously with injections (e.g., hypertonic saline, corticosteroids, analgesics).

Visualization optionsEndoscopic approaches provide direct 3-dimensional visualization to steer the catheter toward adhesions; percutaneous approaches rely on fluoroscopic epidurography.

Frequency limits

Frequency limitsNo frequency limits specified in these policy chunks.

Policy history notePolicy history entries reviewed between 2020 and 2025 indicate no changes to policy statement or coding; frequency limits not added in reviews.

Implication for providersBecause no frequency limits are specified, authorization/benefit verification should be performed per member plan rules; procedure remains investigational and not covered.

Imaging and Procedural Visualization

Documentation Required

Use fluoroscopy or endoscopic visualization for the procedure

The procedure commonly uses fluoroscopic guidance or endoscopic visualization according to the policy; providers should use fluoroscopic epidurography or direct endoscopic visualization when performing the technique.

Fluoroscopically guided catheter placement (epidurography) is commonly used.
Endoscopic approaches use direct 3-dimensional visualization to steer the catheter.

Note

NICE guidance cited — no extra imaging mandates in policy

The policy references NICE Interventional Procedure Guidance 333 on therapeutic endoscopic division of epidural adhesions but does not specify additional imaging requirements beyond the procedural descriptions.

NICE IPG333 is cited as external guidance.
No additional imaging mandates are specified in the provided excerpts.

Specific Procedures Not Covered

The following procedures are identified as not covered: catheter-based percutaneous lysis of epidural adhesions and endoscopic epidurolysis / spinal endoscopic adhesiolysis. These are listed as investigational in the coding/coverage statements.

Consistent with the policy's investigational determination, catheter-based percutaneous lysis of epidural adhesions and endoscopic epidurolysis / spinal endoscopic adhesiolysis are specified as not covered in the coding/coverage information.

No additional procedures or specific indications beyond the investigational exclusions are explicitly identified as not covered in the policy history or related administrative sections.