These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.
Prior authorization is not applicable for discography and intradiscal steroid injections because they are considered investigational/experimental. The provider and facility will be liable for payment unless:
- The provider notifies the member that a specific service has been determined by HealthPartners to be investigational/experimental; and
- The member signs a waiver agreeing to pay for the specific non-covered service being rendered; and
- The claim has been billed with a GA modifier indicating such. If the member has signed a waiver agreeing to pay for the specific service then the member will be liable for payment
Discography, including functional anesthetic discography, and intradiscal injections are considered investigational/experimental and therefore not covered.
Discography - an invasive diagnostic tool and is typically performed in conjunction with CT or MRI to localize disc herniation or fissure in the annulus fibrosis. A volume of contrast media is injected into the disc space to determine the integrity of the intervertebral disc. In the normal disc, the annulus fibrosis solidly encloses the nucleus pulposus and is only capable of accepting 1 to 1.5 ml of contrast media. If 2 ml or more of contrast media can be injected, there is likely a degenerative change in the disc. In addition to determining the available volume of the disc, discography is used to reproduce the symptoms associated with a possible herniated disc. The patient's response to pain can help confirm the source of the symptoms. When saline or dye is injected, it pressurizes the disc, and the patient is able to confirm that this pain is the same as the pain he or she has been having.
Functional anesthetic discography (FAD) is a diagnostic procedure that involves the injection of a local anesthetic (e.g., lidocaine or bupivacaine) directly into one or more suspected discs using a balloon-anchored catheter for confirming the presence of injured discs as the source of a member's LBP. In particular, FAD entails a functional examination; it relies on the member's induction of pain during active patient movement, which is different than the traditional discography. When the member performs the movement or position that causes pain, a local anesthetic is then injected into the disc in hopes of alleviating the pain. If the injection relieves the pain, the disc can be further evaluated for potential treatment. If the injection fails to relieve the pain, the physician can investigate other possible causes of pain.
Intradiscal steroid injection is sometimes performed at the same time as a discography is performed. This procedure lacks scientific evidence that proves its effectiveness.
If available, codes for a procedure, device or diagnosis are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all inclusive.
Unlisted procedure, spine, when used to report intradiscal steroid injections
Discography, cervical or thoracic, radiological supervision and interpretation
Discography, lumbar, radiological supervision and interpretation
Injection procedure for discography, each level; lumbar
Injection procedure for discography, each level; cervical or thoracic
Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar
Unlisted procedure, nervous system, when used to report functional anesthetic discography
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This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy, contact Member Services at 952-883-7979 or 1-800-233-9645.
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