Traditional MedicareCoverageMedium impact
Thermal Destruction of the Intraosseous Basivertebral Nerve (BVN) for Vertebrogenic Lower Back Pain
Medicare/CMS - LCD·Pain Management, Neurosurgery, Orthopedics +1 more·Local Coverage Determination
Effective date
Jul 15, 2026
We identified it
Jul 28, 2026
Summary
Wellpoint Federal has issued a new Local Coverage Determination (LCD L40302) effective 7/15/2026 establishing coverage criteria for thermal destruction of the intraosseous basivertebral nerve (BVN) to treat vertebrogenic lower back pain. This procedure is now a covered service under Medicare Part A and Part B when medical necessity criteria are met. Billing teams must implement prior authorization requirements and ensure proper documentation of patient eligibility and clinical indications.
Action Required
By 7/15/2026: Billing and clinical teams must (1) obtain prior authorization from Wellpoint Federal before scheduling or billing for thermal destruction of the intraosseous basivertebral nerve procedures; (2) add LCD L40302 coverage criteria to the provider education materials and billing system notes; (3) update EMR documentation templates to capture required clinical indicators for vertebrogenic lower back pain diagnosis and medical necessity; (4) train front desk and authorization staff to route all BVN thermal destruction requests to Wellpoint for pre-service review. Claims submitted without prior authorization or failing to meet LCD criteria will be denied. Contact Wellpoint Federal MAC at the provider relations line to establish authorization protocols. This applies only to Wellpoint Federal Medicare beneficiaries in their service area.