CurrentPremera BluecrossPolicy 7.01.564

Pulsed Radiofrequency for the Treatment of Chronic Pain

Defines Premera's medical policy stance that pulsed radiofrequency (PRF) for treatment of various chronic pain syndromes is considered investigational/unproven and therefore not covered. Lists many specific pain indications considered investigational, coding guidance, related evidence, and history of policy updates.

Policy Summary

PayerPremera Bluecross

PolicyPulsed Radiofrequency for the Treatment of Chronic Pain

Policy CodePolicy 7.01.564

Change TypeAnnual review updates to investigational list

Effective Date

Next Review Date

Key ActionPulsed radiofrequency for the listed chronic pain syndromes is considered investigational and therefore not reimbursed; providers should consult member benefit booklet for specific plan limits.

SourceLink

POLICY UPDATE CHANGES

04/01/26 history entry shows annual review with additions to investigational list.

10/01/24 Annual Review: Added anterior cutaneous nerve entrapment syndrome, carpal tunnel syndrome, and frozen shoulder to investigational list.

09/01/25 Annual Review: Added auriculotemporal neuralgia, genitofemoral neuralgia, and postoperative abdominal wall pain to the investigational list; title changed to 'Pulsed Radiofrequency for the Treatment of Chronic Pain.'

~60Indications listed as investigational

1Unlisted CPT code specified

No NCDMedicare national coverage determination

Coverage Summary

Premera considers pulsed radiofrequency (PRF) for the treatment of various chronic pain syndromes investigational / not covered. The policy lists many specific chronic pain indications for which PRF is considered investigational and therefore not reimbursed. The evidence base is limited and consists primarily of small randomized trials, nonrandomized and uncontrolled studies, and case reports with inconsistent findings and methodological limitations. Overall evidence strength: Insufficient to determine effects on health outcomes (limited, low-quality RCTs and inconsistent findings).

Policy number7.01.564

SubjectPulsed radiofrequency for treatment of chronic pain

Last review date2026-03-10

StatusCURRENT

Indications listed as investigational~60

Unlisted CPT code specified1 (CPT 64999)

Investigational / Not Medically Necessary Criteria

Investigational / Not Medically Necessary

Pulsed radiofrequency for the treatment of various chronic pain syndromes is considered investigational including, but not limited to, the following:

ref

Coding Guidance

Unlisted procedure code for pulsed radiofrequencyCPTNot Covered

64999

Unlisted procedure, nervous system

Provider Actions / Billing

Documentation Required

Do not cover - investigational

Pulsed radiofrequency (PRF) for the listed chronic pain syndromes is considered investigational and is not reimbursed. Providers should consult the member benefit booklet or contact a member service representative to determine specific plan limits and coverage for this service.

64999

Background and Evidence

Pulsed radiofrequency (PRF) delivers short bursts of radiofrequency energy to nervous tissue at temperatures kept below neurodestructive thresholds (approximately 42°C), allowing higher voltage electrical fields with intervals for cooling. It is a non- or minimally neurodestructive neuromodulation technique theorized to modulate ion channels, neurotransmitters, synaptic function, and immune activity, and is proposed to produce pain relief with fewer complications than continuous (thermal) radiofrequency ablation; however its precise clinical benefits remain under study.

Overall evidence strength: Insufficient to determine effects on health outcomes (limited, low-quality RCTs and inconsistent findings). The published literature includes a small number of randomized controlled trials, nonrandomized controlled trials, prospective uncontrolled trials, retrospective studies, case series, and case reports. Many uncontrolled and observational studies report clinical efficacy, but controlled data are limited and inconsistent, and long-term comparative effectiveness versus conventional treatments is unknown.

Hayes HTA findings (selected): Multiple condition-specific Hayes Health Technology Assessments (2021–2025) report low or very low quality evidence and conclude there is insufficient support for routine use. Examples summarized in the policy include: chronic postherpetic neuralgia (June 2025) — low quality, no significant clinical benefit; chronic cervical spinal pain (June 2025) — low quality, few comparative studies; lumbosacral radicular pain/dorsal root ganglion (July 2021) — very low quality with small RCTs (28–44 subjects); chronic low back pain from the sacroiliac joint (Dec 2025) — very low quality; chronic shoulder pain (Sept 2025) — low quality and lack of long-term follow-up; and pudendal neuralgia (Nov 2025) — only poor quality studies without comparators or long-term follow-up.

Pulsed radiofrequency (PRF)

Medicare Coverage

There is no national coverage determination. National Coverage: There is no national coverage determination. (Determination name/type: National Coverage; Type: NCD.)

Revision History

04/01/26annual_reviewLatest

Annual Review, Approved March 10, 2026; references added and added to the list of chronic pain syndromes for which pulsed radiofrequency is considered investigational.

09/01/25annual_review

Annual Review: Added auriculotemporal neuralgia, genitofemoral neuralgia (scrotal or groin pain post-herniorrhaphy), and postoperative abdominal wall pain (incisional pain outside of anterior cutaneous nerve entrapment) to the investigational list; policy title changed to 'Pulsed Radiofrequency for the Treatment of Chronic Pain.'

10/01/24annual_review