LCD/NCD Portal

NCD160.1

 

INDUCED LESIONS OF NERVE TRACTS

 

 

Effective Date of this Version

• This is a longstanding national coverage determination.

• The effective date of this version has not been posted.

 

Benefit Category

• Physicians' Services.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Item/Service Description

• Surgically induced lesions of nerve tracts, which involve destruction of nerve tissue, are primarily indicated for controlling the chronic or acute pain arising from conditions such as:

 Terminal cancer.

 Lumbar degenerative arthritis.

o Induced lesions of nerve tracts may be produced:

• By surgical cutting of the nerve (rhizolysis), chemical destruction of the nerve.

• By creation of a radio-frequency lesion (electrocautery).

• Note that these procedures differ from those employing implanted electrodes and associated equipment to control pain in that the nerve fibers are ablated rather than stimulated and no electronic equipment is required by the patient after the operation.

 

Indications and Limitations of Coverage

• Accordingly, program payment may be made for these denervation procedures when used in selected cases (concurred in by contractor's medical staff) to treat chronic pain.

 

 

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