News & Press: Advocacy

Empire BlueCross BlueShield’s Genicular Nerve RFA Policy Ignores Safety and Effectiveness Evidence

Thursday, March 7, 2019  

The Spine Intervention Society (SIS) is concerned that Empire BlueCross BlueShield’s genicular nerve blocks and ablation for chronic knee pain policy is not consistent with current evidence. On behalf of the patients covered by Empire BlueCross BlueShield in 28 eastern and southeastern counties of New York State, on February 20, 2019, SIS issued a comment letter to the insurer, countering their inaccurate classification of radiofrequency ablation (RFA) of peripheral nerves to treat pain associated with knee osteoarthritis (OA) as investigational.

SIS is an active advocate on behalf of patients and practitioners and has recently addressed this particular coverage issue with the following insurers:

The evidence shows that RFA of the genicular nerves is a valuable treatment for patients suffering from chronic knee pain and for patients with residual pain after total knee arthroplasty. Further, the procedure is indicated and may be the only option for patients who are not surgical candidates or who choose not to have surgical treatment. Acknowledging the strength and quality of the evidence in support of the safety and effectiveness of genicular nerve RFA, the American Medical Association’s Current Procedural Terminology (CPT®) Editorial Panel has approved a Category I code for the procedure that will go into effect on January 1, 2020.

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