Effective for dates of service on or after June 14, 2026, Carelon Medical Benefits Management, Inc., will implement updates to its Clinical Appropriateness Guidelines as part of the Musculoskeletal program. These revisions reflect Carelon’s annual review process and support continued efforts to promote clinically appropriate, safe, and cost-effective care.
Interventional Pain Management Updates
- Epidural Steroid and Intradiscal Injections
- Removed limits on cumulative steroid dosing; recommend notifying the primary care provider when repeat steroid use is prolonged.
- Therapeutic Epidural Steroid Injections
- Removed transforaminal injections from those permitted without advanced imaging.
- Lysis of Epidural Adhesions
- Added to guidelines as not medically necessary.
- Intraosseous Basivertebral Nerve Ablation
- Removed requirements for:
- Oswestry Disability Index ≥ 30.
- Behavioral/medical provider attestation of no untreated mental health conditions.
- Added requirement that non-surgical management be supervised.
- Added exclusion for same day performance with other spine procedures.
- Removed requirements for:
- Medial Branch Block or Radiofrequency Neurotomy
- Clarified that exclusion for moderate to severe spondylolisthesis applies only when dynamic instability is present.
- Removed exclusion for procedures in the setting of isolated pars defects.
- Diagnostic Regional Sympathetic Block
- Added requirements that prior blocks:
- Reduce pain by ≥ 80% for the expected anesthetic duration.
- Produce a temperature increase of ≥ 2°C from baseline.
- Added exclusions for bilateral blocks and for blocks across more than one region.
- Added requirements that prior blocks:
- Sacroiliac Joint Injections
- Clarified that the maximum of two diagnostic injections may be unilateral or bilateral.
- Spinal Cord and Dorsal Root Ganglion Stimulators
- Added criteria for stimulator replacement.
- Added allowance for replacement, revision, or removal at end of service.
- Removed “loss of effectiveness” criterion, as this is addressed under end of service guidelines.
You can review the full Interventional Pain Management guidelines on Carelon's website.
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