Percutaneous Adhesiolysis Is Now Covered in All States

June 13, 2022
Percutaneous adhesiolysis has faced multiple issues related to coverage in the past few years. Initially, Noridian issued a noncoverage decision, followed by Palmetto issuing an experimental procedure decision.

Since then, we have incorporated into discussions on epidural LCD. While it was discussed in epidural LCD, it was not issued in the final consideration. We continued our efforts for coverage of this procedure and general consensus was that they all will be covering as any other Medicare services in the absence of a particular policy. We continue to face questions with Palmetto and Noridian.

After many years of advocacy, we have finally succeeded in getting coverage for this important procedure in all states, including all Palmetto and Noridian states in the United States.

We are very grateful to the Multijurisdictional Committee that convened considering epidural injections on 2/11/2021 for considering percutaneous adhesiolysis. We are also grateful to the Medical Directors of Palmetto and Noridian MACs for their prompt response. 

Enclosed, please see the letters written to Palmetto and Noridian and the responses from Palmetto and Noridian.

It is crucial to perform these procedures based on appropriate indications and medical necessity. ASIPP epidural guidelines show the evidence basis, as well as indications and medical necessity, in addition to numerous other systematic reviews and randomized controlled trials.

Enclosed, please find a review of indications and medical necessity from epidural guidelines. You may also visit the entire guideline for further information. 

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