Nucleoplasty
Nucleoplasty (S2348) is considered experimental/investigational, as there are no long term studies to support or prove the safety and efficacy of this procedure. Nucleoplasty is not covered and not eligible for reimbursement or payment. A participating, preferred, or network provider can bill the member for this service.

Date Last Reviewed: 06/2006

Biacuplasty
Biacuplasty (64999) is considered experimental/investigational as published data are inadequate to permit scientific conclusions regarding the saftey and efficacy of this procedure.  Biacuplasty is not covered and not eligible for payment.  A participating, preferred, or network provider can bill the member for this service.

Date Last Reviewed: 06/2007

NOTE:

See Medical Policy Bulletin S-83 for guidelines on Percutaneous Lumbar Discectomy (PLD).

NOTE:

See Medical Policy Bulletin S-169 for guidelines on Intradiscal Electrothermal Annuloplasty (IDEA) or Intradiscal Electrothermal Therapy (IDET).

Description

Nucleoplasty is a minimally invasive percutaneous procedure performed under local anesthesia to decompress herniated vertebral discs for the relief of chronic back pain. A special radiofrequency probe (Perc-D Spine Wand™) is inserted percutaneously into the nucleus pulposis under fluoroscopic guidance. Radiofrequency energy is used to break up the molecular bonds of the gel in the nucleus of the disc, essentially vaporizing a portion of it. Upon withdrawal of the wand, tissue is thermally coagulated. The intent of the procedure is to decompress the disc thereby reducing the pressure on surrounding nerve roots.

Biacuplasty is a minimally invasive percutaneous procedure performed under local anesthesia for the treatment of chronic discogenic pain originating from annular fissures or contained disc herniations.  The biacuplasty procedure uses a bipolar approach in conjunction with internally water-cooled radiofrequency probes to coagulate and deactivate nerves while decompressing disc material.  Under fluoroscopy, two introducers are placed bilaterally in the posterolateral disc and the radiofrequency (TransDiscal™) probes are inserted into the introducers.  The radiofrequency energy is applied and directed through the disc between the two probe electrodes.  This concentrated energy results in tissue heating around and between the electrodes, which coagulates and decompresses disc material, reducing pressure on nearby nerves..

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

This medical policy may not apply to FEP.  Medical policy is not an authorization, certification, explanation of benefits, or a contact.  Benefits are determined by the Federal Employee Program.

Percutaneous Disc Decompression in the Management of Chronic Low Back Pain, Orthopedic Clinics of North America, Vol. 35(1), January 2004

Nucleoplasty With or Without Intradiscal Electrothermal Therapy (IDET) as a Treatment for Lumbar Herniated Disc, Journal of Spinal Disorders & Techniques, 18 Supplement, February 2005

Quality of Life Assessment in Patients Undergoing Nucleoplasty-Based Percutaneous Discectomy, Journal of Neurosurgery. Spine, Vol. 4(1), January 2006

National Blue Cross Blue Shield Association Medical Policy 7.01.93, Decompression of the Intervertebral Disc Using Laser (Laser Discectomy) or Radiofrequency (DISC Nucleoplasty™) Energy, 03/2006

A Novel Radiofrequency Annuloplasty (Transdiscal Biacuplasty) for the Treatment of Lumbar Discogenic Pain: 6-Month Results of the Pilot Study, American Academy of Pain Medicine, February, 2007

Novel Intradiscal Biacuplasty (IDB) for the Treatment of Lumbar Discogenic Pain, Pain Practice: the Official Journal of World Institute of Pain, Vol. 2(2), June 2007