CommercialCoverageHigh impact
Radiofrequency Facet and Sacroiliac Joint Ablation/ Denervation 7.01.42
Excellus BlueCross BlueShield·Orthopedics, Pain Management, Neurosurgery +1 more·Bone & Joints (Orthopedic)
Effective date
Oct 15, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their policy for radiofrequency facet and sacroiliac joint ablation/denervation, effective October 15, 2025. The policy establishes specific criteria for initial and repeat procedures, including requirements for 3+ months of pain, 4+ weeks of conservative treatment, positive response to two diagnostic injections with 80% pain relief, and mandatory 6-month intervals between repeat procedures.
Action Required
Before October 15, 2025: Billing and clinical teams must update prior authorization workflows for Excellus BCBS radiofrequency ablation procedures. Ensure documentation includes: 3+ months pain duration, 4+ weeks conservative treatment, two sequential diagnostic injections with 80% pain relief lasting minimum anesthetic duration, and unfused spinal segments. For repeat procedures, document 50% pain relief lasting 12+ weeks and minimum 6-month interval from prior procedure. Update encounter forms to capture these requirements. Claims missing these criteria will be denied.