ModifiedExcellus Health Plan IncPolicy 7.01.112

Intradiscal Procedures

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This policy governs coverage of intradiscal decompression, annuloplasty, radiofrequency, and injection procedures, which are considered investigational for members seeking these services.

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ModifiedExcellus Health Plan IncPolicy 7.01.112

Intradiscal Procedures

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This policy governs coverage of intradiscal decompression, annuloplasty, radiofrequency, and injection procedures, which are considered investigational for members seeking these services.

Policy Summary

PayerExcellus Health Plan Inc

PolicyIntradiscal Procedures

Policy CodePolicy 7.01.112

Change TypeModified annual review

Effective DateOctober 15, 2026

Last ReviewJun 18, 2026

Next Review DateJune 1, 2027

Key ActionDo not assume coverage for listed intradiscal procedures because they are designated experimental/investigational and may be excluded by the member’s benefit.

SourceLink

POLICY UPDATE CHANGES

Several new intradiscal procedures were added to the investigational policy statement during the 2026 annual review.

CPT codes 62330 and 62331 were added effective January 1, 2026, to replace code 0275T.

15Investigational intradiscal procedure categories

E/IExperimental/investigational procedure codes

3HCPCS codes listed

4New or replacement CPT codes

Coverage Criteria

Investigational intradiscal procedures

Intradiscal procedures are considered investigational.

Investigational intradiscal procedure: The requested service is an intradiscal procedure included in the investigational list, including annulo-nucleoplasty, cervical intradiscal radiofrequency lesioning, coblation percutaneous disc decompression, hydrodiscectomy, intradiscal biacuplasty, intradiscal electrothermal or thermal annuloplasty, nucleoplasty, automated percutaneous lumbar discectomy, percutaneous laser or plasma disc decompression, percutaneous intradiscal radiofrequency thermocoagulation or thermomodulation, radiofrequency annuloplasty, targeted disc decompression, or an intradiscal injection.

The listed examples are not all-inclusive; intradiscal injections are expressly described as not an all-inclusive list.

Experimental, investigational, or inadequately supported intradiscal procedures

The reviewed evidence is insufficient, conflicting, or does not support efficacy for several intradiscal procedures.

Procedure with insufficient, conflicting, or unsupported evidence: The requested procedure is automated percutaneous discectomy, minimally invasive lumbar decompression, intradiscal electrothermal annuloplasty (IDET/IDTA), percutaneous intradiscal radiofrequency thermocoagulation (PIRFT), laser discectomy, or nucleoplasty, for which the available evidence is insufficient, conflicting, limited, or does not support efficacy or improvement in health outcomes.

The evidence limitations and methodological concerns vary by procedure.

Experimental or investigational coded procedure: The requested procedure is percutaneous intradiscal electrothermal annuloplasty at a single level or one or more additional levels, reported with CPT code 22526 or 22527, respectively.

These codes are designated experimental/investigational; codes may not be covered under all circumstances and the code list may not be all-inclusive.

Coding Information

Experimental/Investigational CPT CodesCPTExperimental

22526	Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level
22527	one or more additional levels (list separately in addition to code for primary procedure)

CPT CodesCPTExperimental

22526	Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level.
22527	One or more additional levels; list separately in addition to code for primary procedure.
62287	Decompression, 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.
62330	Effective 01/01/26: Decompression, percutaneous, with partial removal of the ligamentum flavum, including laminotomy for access, epidurography, and imaging guidance (i.e., CT or fluoroscopy), bilateral; one interspace, lumbar. Replacing code 0275T.
62331	Effective 01/01/26: Decompression, percutaneous, with partial removal of the ligamentum flavum, including laminotomy for access, epidurography, and imaging guidance (i.e., CT or fluoroscopy), bilateral; additional interspace(s), lumbar. Replacing code 0275T.
0275T	Termed 12/31/2025; percutaneous laminotomy/laminectomy (interlaminar approach) for decompression.
0274T	Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy, any method, under indirect image guidance (e.g., fluoroscopic, CT), single or multiple levels, unilateral or bilateral; lumbar.
0627T	Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; first level.
0628T	Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; each additional level.
0629T	Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with CT guidance, lumbar; first level.

1–10 of 11

1/2

HCPCS CodesHCPCSExperimental

C2614	Probe, percutaneous lumbar discectomy.
G0276	Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (PILD) or placebo-control, performed in an approved coverage with evidence development (CED) clinical trial.
S2348	Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, using radiofrequency energy, single or multiple levels, lumbar.

ICD-10 CodesICD-10

M43.12-M43.17	Spondylolisthesis.
M48.02-M48.07	Spinal stenosis.
M50.20-M50.23	Other cervical disc displacement.
M50.33	Description not provided in the document text.
M51.06	Intervertebral disc disorders with myelopathy, lumbar region.
M51.16	Intervertebral disc disorders with radiculopathy, lumbar.
M51.17	Description not provided in the document text.
M51.24-M51.27	Description not provided in the document text.
M51.34-M51.37	Other intervertebral disc degeneration.
M51.9	Unspecified thoracic, thoracolumbar and lumbosacral intervertebral disc disorder.

Provider and Billing Actions

Denial Risk

Investigational intradiscal procedures are not covered

Coverage is not available under this policy for intradiscal procedures considered investigational, including the listed decompression, annuloplasty, radiofrequency, nucleoplasty, discectomy, and intradiscal injection procedures.

Denial Risk

IDET/IDTA codes carry an experimental designation

Percutaneous intradiscal electrothermal annuloplasty is designated experimental/investigational under CPT codes 22526 and 22527. Claims for IDET/IDTA reported with these codes may be denied.

22526: single-level percutaneous intradiscal electrothermal annuloplasty, including fluoroscopic guidance.
22527: one or more additional levels, reported with the primary procedure code.

Denial Risk

Clinical Background

Intradiscal procedures are minimally invasive techniques intended to address discogenic pain associated with annular disruption, contained herniated discs, annular tears or fissures, and internal disc derangement. Depending on the technique, treatment may involve placing a probe or catheter into the disc to deliver radiofrequency or electrothermal energy, injecting agents into the nucleus pulposus or annulus, decompressing disc material through percutaneous or endoscopic methods, supplementing disc tissue with an allogeneic cellular or tissue-based product, or using nucleoplasty to ablate disc tissue. The policy considers these procedures investigational because the supporting evidence is limited, conflicting, or insufficient to establish improved health outcomes; for example, one randomized study reported successful outcomes in 29% of percutaneous-discectomy patients compared with 80% of microdiscectomy patients.

Procedure Definitions

Intradiscal procedures

Procedure categoryMinimally invasive surgical procedures for symptomatic individuals with discogenic pain attributed to annular disruption of a contained herniated disc.

Clinical indicationsMay be used to seal annular tears or fissures or destroy nociceptors to relieve pain.

Methods includedIncludes percutaneous intradiscal probe placement with radiofrequency or electrothermal energy, injection of agents into the disc, and percutaneous decompression using direct or indirect visualization.

Thermal intradiscal techniques

Technique categoryIntradiscal procedures using one or more probes or catheters to deliver thermal energy.

Delivery systemThe probes or catheters use a resistance coil or another delivery-system technology and may be flexible or rigid.

Imaging Requirements

Billing Rule

Apply the required imaging guidance

Use the imaging guidance specified for the procedure. Automated percutaneous discectomy is performed under fluoroscopic guidance; endoscopic techniques use image guidance; and IDET/IDTA requires catheter insertion under fluoroscopy.

APD/APLD: fluoroscopic guidance.
Endoscopic techniques: image guidance for placement of the working channel.
IDET/IDTA: fluoroscopy for spinal-catheter insertion.

Billing Rule

Follow code-specific fluoroscopic or CT guidance

Report the procedure with the imaging guidance specified in the applicable code description. The listed procedures require fluoroscopic, CT, or other indirect image guidance as applicable, including fluoroscopy or CT for percutaneous decompression, laminotomy/laminectomy, and cellular or tissue-based disc injections.

Not Covered Services

Investigational intradiscal procedures: Annulo-nucleoplasty (Disc-FX); cervical intradiscal radiofrequency lesioning; coblation percutaneous disc decompression; hydrodiscectomy; intradiscal biacuplasty; intradiscal electrothermal annuloplasty; intradiscal thermal annuloplasty; nucleoplasty, including percutaneous radiofrequency thermomodulation or percutaneous plasma discectomy; automated percutaneous lumbar discectomy; percutaneous laser disc decompression; percutaneous or plasma disc decompression; percutaneous intradiscal radiofrequency thermocoagulation or thermomodulation; radiofrequency annuloplasty; targeted disc decompression; and intradiscal injections, including methylene blue, hyaluronate, ozone or oxygen/ozone, bone marrow concentrates, chymopapain, platelet-rich plasma, mesenchymal stem cells, glucocorticoids, hyaluronidase, and growth factor. The injection examples are not all-inclusive.

Procedures designated experimental/investigational (E/I): Percutaneous intradiscal electrothermal annuloplasty, percutaneous disc decompression, percutaneous laminotomy/laminectomy or ligamentum flavum decompression, intradiscal allogeneic cellular or tissue-based product injection, percutaneous lumbar discectomy, percutaneous image-guided lumbar decompression or placebo-control procedures performed in an approved coverage-with-evidence-development trial, and radiofrequency percutaneous nucleus pulposus decompression. These procedures may not be covered under this policy; coverage also depends on the member’s product benefit and applicable Medicare or New York Medicaid criteria where relevant.

Policy Summary

PayerExcellus Health Plan Inc

PolicyIntradiscal Procedures

Policy CodePolicy 7.01.112

Change TypeModified annual review

Effective DateOctober 15, 2026

Last ReviewJun 18, 2026

Next Review DateJune 1, 2027

Key ActionDo not assume coverage for listed intradiscal procedures because they are designated experimental/investigational and may be excluded by the member’s benefit.

SourceLink

On This Page

Verify benefit applicability before billing

The listed intradiscal procedure codes are designated experimental/investigational and may not be covered. Before providing or billing these services, verify the member’s product benefit and, where applicable, Medicare or New York Medicaid coverage criteria.

The code list may not be all-inclusive.
AMA and CMS code updates may occur more frequently than policy updates.

Placement sitesDevices are placed within the nucleus pulposus, the nuclear-annular junction, or the annulus.

Automated percutaneous discectomy (APD/APLD)

Procedure typeA fluoroscopically guided percutaneous discectomy procedure.

Cannula placementA cannula is placed centrally within the disc through a posterolateral approach on the symptomatic side.

Disc removalAn automated cutting and aspiration device removes nuclear material through a probe until no more material can be obtained.

Endoscopic techniques

Procedure typePercutaneous discectomy performed through a working channel placed under image guidance.

VisualizationThe working space and instruments are visualized through an endoscope, and decompression is performed under visual control.

ApproachesTechniques may be intradiscal or may extract non-contained and sequestered disc fragments through an interlaminar or transforaminal approach.

Intradiscal annuloplasty therapies

Therapeutic basisRadiofrequency-based therapies that thermally treat the annulus for discogenic low back pain arising from annular tears or internal disc derangement.

Intended effectsMay decrease annular pain, enhance structural integrity, stabilize the disc, or seal annular fissures.

Pain mechanism addressedProposed pain reduction may occur through thermal coagulation of nociceptors in the outer annulus.

Intradiscal electrothermal annuloplasty (IDET/IDTA)

Procedure typeA minimally invasive treatment for discogenic low back pain intended to treat the protein wall of the disc and reduce disc material that causes nerve irritation.

Catheter placementA spinal catheter is inserted through a needle into the disc under fluoroscopy.

Thermal treatmentIndirect radiofrequency energy heats the catheter to 194°F (90°C) for up to 20 minutes.

Percutaneous intradiscal thermocoagulation (PIRFT)

Procedure typeA radiofrequency thermocoagulation procedure using a probe placed in the center of the disc rather than around the annulus.

Activation parametersThe probe is activated for 90 seconds at 70°C.

Proposed mechanismThe procedure is thought to reduce nociceptive pain input from free nerve endings in the outer annulus fibrosis.

Intradiscal biacuplasty

Procedure typeA procedure using two cooled radiofrequency electrodes to treat the intervertebral annulus fibrosis.

Electrode placementThe electrodes are placed on the posterolateral sides of the intervertebral annulus fibrosis.

Proposed treatment areaCooling the probes is intended to allow treatment of a larger area than a regular needle probe.

Viable allograft supplemental disc regeneration (VAST/Via Disc)

Product namesViable allograft supplemental disc regeneration is also known as VAST or Via Disc.

Procedure typeA therapeutic percutaneous lumbar-spine injection.

Product and purposeAn allogeneic cellular or tissue-based product is injected to replace or supplement disc tissue and repair or reconstitute a damaged intervertebral disc.

Disc nucleoplasty

Technique categoryA bipolar radiofrequency or coblation technique used to treat intervertebral disc tissue.

Tissue treatmentHeat or a low-temperature plasma field ablates tissue while minimizing thermal damage to collateral tissue.

Resulting channelsIonized particles break organic molecular bonds and create small channels in the disc.

E/I

AbbreviationE/I

MeaningExperimental/Investigational

Policy useIdentifies services or procedures designated experimental or investigational.

NMN

AbbreviationNMN

MeaningNot medically necessary/appropriate

Policy useIdentifies services or procedures designated not medically necessary or appropriate.

CPT 62287: fluoroscopic imaging or other indirect visualization.
CPT 62330 and 62331: CT or fluoroscopy imaging guidance.
CPT 0274T: indirect image guidance, such as fluoroscopic or CT guidance.
CPT 0627T and 0628T: fluoroscopic guidance; CPT 0629T and 0630T: CT guidance.