Nucleoplasty 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.

NOTE:

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

Description

Nucleoplasty (S2348) 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.

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.

Under the Federal Employees Program, all services that utilize FDA-approved drugs, devices, or biological products are eligible when intended for the treatment of a serious or life-threatening condition and when medically necessary and appropriate for the patient's condition. Nucleoplasty is considered an eligible service when determined medically necessary based on the patient's condition.

PRN References

12/2002, Nucleoplasty considered investigational