Apply UHC Latest Thermal RFA Policy

Practice participates with United HealthCare (UHC), you will want to take note of UHC’s recent policy update on ablative treatment of spinal pain.

CPT coding, medical coding

If your practice participates with United HealthCare (UHC), you will want to take note of UHC’s recent policy update on ablative treatment of spinal pain. Although UHC has a limited coverage policy for a number of spinal pain and facet joint pain procedures, you have some opportunity of reimbursement if you are aware of the rules.

Ablation method and frequency matter

Among the changes are revised coverage policies for how often the thermal radiofrequency ablation can be carried out and reimbursed. According to the policy, that thermal RFA is covered when carried out at three months or greater frequency, provided there has been a 50 percent or greater documented reduction in pain.

For instance: On May 15, 2010, the doctor carries a repeat thermal radiofrequncy (RF) ablation on the right L4 and L5 paravertebral facet joint nerves on a patient with right lumbar facet joint pain. You would report codes 64622 and +64623.

Reimbursement difficult for thermal RF treatment

At first glance, UHC’s policy toward thermal radiofrequency ablation can seem disheartening at first glance. The policy’s coverage rationale points out a number of conditions for which treatment for spinal or orthopedic pain is not covered.

Fluoroscopic guidance called for

One such guideline is the necessity of fluoroscopic guidance when a physician carries out these procedures.

Pulsed radiofrequency, other ablations not covered

Practices that make use of emerging techniques to tend to chronic spinal pain will also be in for some disappointments. The updated UHC policy considers pulsed RF therapy, cryoablation, alcohol ablation, and laser ablation to be unproven for spinal/facet joint pain and as such, not covered.

However, the coverage climate could be changing. If future studies showcase the safety and efficacy of laternative methods of destructive neurolysis, it’s possible that third-party payers may reconsider their non-coverage decision. The rapid growth of these types of procedures using a number of methods is leading more payers to examine the published medical evidence for a particular method, with subsequent revision of prior coverage polices.

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