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Medical Policy Update: Ablation / Denervation Techniques for Knee Pain

Audience: Anesthesiologists and orthopedic surgeons

Excellus BlueCross BlueShield works to ensure that the development of corporate medical policies occurs through an open, collaborative process. We encourage participating providers to become actively involved in medical policy development. Each month, draft policies are available on our website for review and comment here. Providers now have the capability of attaching supporting documentation related to their comments.

The following updated medical policy has been reviewed and was approved on June 16, 2022, by the Corporate Medical Policy Committee, which includes practitioners from all Health Plan regions. 

Corporate Medical Policy 7.01.100 – Ablation/Denervation Techniques for Knee Pain has been updated to be consistent with research findings regarding the use of an IPACK block in multimodal analgesia. This updated policy will be effective October 15, 2022. The policy applies to all lines of business, and to the services of all practitioners and facilities.

The Ablation / Denervation Techniques for Knee Pain policy provides updates to the criteria for the following indications:

  • Post-operative knee pain and functional performance
  • The rationale section of the medical policy provides information related to the Health Plan’s change in coverage criteria based on the current body of literature.

These services are subject to audit and policy updates at the Health Plan’s discretion. Access the individual policies here.

If you have any questions regarding this policy, please contact your Provider Relations representative.

Thank you for the quality of care and service that you provide to our members.

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