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Decision: unknown

 
The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that medically necessary services are those that are reasonable and necessary for the diagnosis or 
treatment of an illness or injury. Medically necessary services include services to improve the functioning of a 
malformed body member. You can find this rule in the Social Security Act, Section 1862(a)(1)(A). 
 
The rules say that services that are not medically necessary are not covered. The rules also say that 
experimental and investigational devices are not covered. You can find this rule at 42 CFR Sections 411.15 and 
411.15(o). 
 
The rules say percutaneous thermal intradiscal procedures (TIPs) involve the insertion of a catheter(s)/probe(s) 
in the spinal disc under fluoroscopic guidance for the purpose of producing or applying heat and/or disruption 
within the disc to relieve low back pain. 
 
The scope of this national coverage determination on TIPs includes percutaneous intradiscal techniques that 
employ the use of a radiofrequency energy source or electrothermal energy to apply or create heat and/or 
disruption within the disc for coagulation and/or decompression of disc material to treat symptomatic patients 
with annular disruption of a contained herniated disc, to seal annular tears or fissures, or destroy nociceptors for 
the purpose of relieving pain. This includes techniques that use single or multiple probe(s)/catheter(s), which 
utilize a resistance coil or other delivery system technology, are flexible or rigid, and are placed within the 
nucleus, the nuclear-annular junction, or the annulus. 
 
Although not intended to be an all inclusive list, TIPs are commonly identified as intradiscal electrothermal 
therapy (IDET), intradiscal thermal annuloplasty (IDTA), percutaneous intradiscal radiofrequency 
thermocoagulation (PIRFT), radiofrequency annuloplasty (RA), intradiscal biacuplasty (IDB), percutaneous (or 
plasma) disc decompression (PDD) or coblation, or targeted disc decompression (TDD). At times, TIPs are 
identified or labeled based on the name of the catheter/probe that is used (e.g., SpineCath, discTRODE, 
SpineWand, Accutherm, or TransDiscal electrodes). Each technique or device has it own protocol for 
application of the therapy. Percutaneous disc decompression or nucleoplasty procedures that do not utilize a 
radiofrequency energy source or electrothermal energy (such as the disc decompressor procedure or laser 
procedure) are not within the scope of this NCD. Indications and Limitations of Coverage 
 
B. Nationally Covered Indications 
 
N/A  
C. Nationally Non-Covered Indications 
 
Effective for services performed on or after September 29, 2008, the Centers for Medicare and Medicaid 
Services has determined that TIPs are not reasonable and necessary for the treatment of low back pain. 
Therefore, TIPs, which include procedures that employ the use of a radiofrequency energy source or 
electrothermal energy to apply or create heat and/or disruption within the disc for the treatment of low back 
pain, are noncovered. You can find this information in Medicare's National Coverage Determination (NCD): 
Thermal Intradiscal Procedures (TIPs) (150.11). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.