Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › GENERAL RULES › Section 20-2-XVI - INVESTIGATIONAL PROCEDURES

Current through June 25, 2024
When the following procedures are performed as
				  investigational procedures they will not qualify for reimbursement under the
				  Mississippi Workers' Compensation Medical Fee Schedule:
A. Intradiscal electrothermal therapy (IDET)
				(22526, 22527) and intradiscal annuloplasty by other method (22899).
B. Intraventricular administration of
				morphine.
C. Pulsed radiofrequency,
				regardless of procedure involved or indication (e.g., medial branch
				radiofrequency, dorsal root radiofrequency, etc.). If pulsed radiofrequency is
				used, but not specifically recorded as such in the medical records, the payer
				may retroactively deny payment for the service and request for reimbursement
				from the provider.
D. Intradiscal
				therapies used in discography, such as percutaneous disc decompression
				(Dekompressor), fluoroscopic, laser, radiofrequency, and thermal disc
				therapies.
E. Percutaneous disc
				nucleoplasty.
F. Epidural
				adhesiolysis, also known as Racz procedure or lysis of epidural
				adhesions.
G. X-STOP fusion
				devices.
H. MILD (minimally
				invasive lumbar decompression) procedures.
I. Non-invasive pain procedure (NIP procedure
				or NIPP).
J. Alpha-stim
				unit.
K. ReBuilder and low laser
				treatment.
L. Botulinum toxin for
				the treatment of musculoskeletal pain.
M. Ketamine infusion therapy.
N. Prolotherapy.
See below for a list of additional procedures that are not
				  reimbursable when performed as investigational procedures.
* AccuraScope procedure.
* Annulo-nucleoplasty (The Disc-FX procedure).
* Annulus repair devices (Xclose Tissue Repair System,
				  Barricaid, Disc Annular Repair Technology (DART) System).
* BacFast HD for isolated facet fusion.
* Biomet Aspen fusion system (an interlaminar fixation
				  device).
* Cervical intradiscal radiofrequency lesioning.
* Chemical ablation (including but not limited to alcohol,
				  phenol or sodium morrhuate) of facet joints.
* Coblation percutaneous disc decompression.
* Coccygeal ganglion (ganglion impar) block for coccydynia,
				  pelvic pain, and all other indications.
* Cooled radiofrequency ablation for facet
				  denervation.
* Cryoablation (cryoanesthesia, cryodenervation,
				  cryoneurolysis, or cryosurgery) for the treatment of lumbar facet joint pain.
* Deuk Laser Disc Repair.. Devices for annular repair (e.g.,
				  Inclose Surgical Mesh System).
* Dynamic (intervertebral) stabilization (e.g., BioFlex, CD
				  Horizon Agile Dynamic Stabilization Device, DSS Dynamic Soft Stabilization
				  System, Dynabolt Dynamic Stabilization System, Dynesys Spinal System, Graf
				  ligamentoplasty/Graf artificial ligament, Isobar Spinal System, NFix, Satellite
				  Spinal System, Stabilimax NZ Dynamic Spine Stabilization System, and the Zodiak
				  DynaMo System).
* Endoscopic disc decompression, ablation, or annular
				  modulation using the DiscFX System.
* Endoscopic laser foraminoplasty, endoscopic foraminotomy,
				  laminotomy, and rhizotomy (endoscopic radiofrequency ablation).
* Endoscopic transforaminal diskectomy.
* Epidural fat grafting during lumbar decompression
				  laminectomy/discectomy.
* Epidural injections of lytic agents (e.g., hyaluronidase,
				  hypertonic saline) or mechanical lysis in the treatment of adhesive
				  arachnoiditis, epidural fibrosis, failed back syndrome, or other indications.
* Epidural steroid injections for the treatment of
				  non-radicular low back pain.
* Epiduroscopy (also known as epidural myeloscopy, epidural
				  spinal endoscopy, myeloscopy, and spinal endoscopy) for the diagnosis and
				  treatment of intractable LBP or other indications.
* Facet chemodenervation/chemical facet neurolysis.
* Facet joint allograft implants (NuFix facet fusion, TruFuse
				  facet fusion).
* Facet joint implantation (Total Posterior-element System
				  (TOPS) (Premia Spine), Total Facet Arthroplasty System (TFAS) (Archus
				  Orthopedics), ACADIA Facet Replacement System (Facet Solutions/Globus Medical).
* Interlaminar lumbar instrumented fusion (ILIF).
* Interspinous and interlaminar distraction devices.
* Interspinous fixation devices (CD HORIZON SPIRE Plate,
				  PrimaLOK SP, SP-Fix Spinous Process Fixation Plate, and Stabilink interspinous
				  fixation device) for spinal stenosis or other indications.
* Intradiscal biacuplasty (IDB)/intervertebral disc
				  biacuplasty/cooled radiofrequency.
* Intradiscal electrothermal annuloplasty (IEA).
* Intradiscal electrothermal therapy (IDET).
* Intradiscal glucocorticoid injection for the treatment of
				  low back pain.
* Intradiscal implantation of combined autologous
				  adipose-derived mesenchymal stem cells and hyaluronic acid for the treatment of
				  discogenic low back pain.
* Intradiscal implantation of stromal vascular fraction plus
				  platelet rich plasma for the treatment of degenerative disc disease.
* Intradiscal infiltration with plasma rich in growth factors
				  for the treatment of low back pain.
* Intradiscal injection of autologous bone marrow concentrate
				  for the treatment of degenerative disc disease.
* Intradiscal injection of platelet-rich plasma.
* Intradiscal methylene blue injection for the treatment of
				  low back pain.
* Intradiscal pulsed radiofrequency for the treatment of
				  discogenic neck pain.
* Intradiscal steroid injections.
* Intradiscal thermal annuloplasty (IDTA).
* Intradiscal, paravertebral, or epidural oxygen or ozone
				  injections.
* Intravenous administration of corticosteroids, lidocaine,
				  magnesium, Toradol or vitamin B12 (cyanocobalamin) as a treatment for back pain
				  and neck pain.
* Khan kinetic treatment (KKT).
* Laser facet denervation.
* Least invasive lumbar decompression interbody fusion
				  (LINDIF).
* Microsurgical lumbar sequestrectomy for the treatment of
				  lumbar disc herniation.
* Minimally invasive endoscopic transforaminal lumbar
				  interbody fusion (endoscopic MITLIF; same as endoscopic MAST fusion) for lumbar
				  disc degeneration and instability or other indications.
* Minimally invasive lumbar decompression (MILD) procedure
				  (percutaneous laminotomy/laminectomy (interlaminar approach) for decompression
				  of neural elements under indirect image guidance) for lumbar canall stenosis or
				  other indications.
* Minimally invasive thoracic discectomy for the treatment of
				  back pain.
* Nucleoplasty (also known as percutaneous radiofrequency
				  thermomodulation or percutaneous plasma diskectomy).
* OptiMesh grafting system.
* Percutaneous (or plasma) disc decompression (PDD).
* Percutaneous cervical diskectomy.
* Percutaneous endoscopic diskectomy with or without laser
				  (PELD) (also known as arthroscopic microdiskectomy or Yeung Endoscopic Spinal
				  Surgery System [Y.E.S.S.]).
* Percutaneous intradiscal radiofrequency thermocoagulation
				  (PIRFT)/intradiscal radiofrequency thermomodulation/percutaneous radiofrequency
				  thermomodulation.
* Piriformis muscle resection and other surgery for
				  piriformis syndrome.
* Posterior intrafacet implants (e.g., DTRAX Cervical Cage)
				  for posterior cervical fusion.
* Psoas compartment block for lumbar radiculopathy or
				  myositis ossification.
* Racz procedure (epidural adhesiolysis with the Racz
				  catheter) for the treatment of members with adhesive arachnoiditis, epidural
				  adhesions, failed back syndrome from multiple previous surgeries for herniated
				  lumbar disk, or other indications.
* Radiofrequency annuloplasty (RA).
* Radiofrequency denervation for sacroiliac joint
				  pain.
* Radiofrequency lesioning of dorsal root ganglia for back
				  pain.
* Radiofrequency lesioning of terminal (peripheral) nerve
				  endings for back pain.
* Radiofrequency/pulsed radiofrequency ablation of trigger
				  point pain.
* Sacroiliac fusion or pinning for the treatment of LBP due
				  to sacroiliac joint syndrome; Note: Sacroiliac fusion may be medically
				  necessary for sacroiliac joint infection, tumor involving the sacrum, and
				  sacroiliac pain due to severe traumatic injury where a trial of an external
				  fixator is successful in providing pain relief.
* Sacroiliac joint fusion (e.g., by means of the iFuse System
				  and the SImmetry Sacroiliac Joint Fusion System).
* Sacroplasty for osteoporotic sacral insufficiency fractures
				  and other indications.
* Targeted disc decompression (TDD).
* Total Facet Arthroplasty System (TFAS) for the treatment of
				  spinal stenosis.
* Vesselplasty (e.g., Vessel-X).
The following chiropractic procedures are considered
				  experimental and investigational and therefore, do not qualify for
				  reimbursement under the Mississippi Workers' Compensation Medical Fee
				  Schedule.
* Active Release Technique.
* Active Therapeutic Movement (ATM2).
* Advanced Biostructural Correction (ABC) Chiropractic
				  Technique.
* Applied Spinal Biomechanical Engineering.
* Atlas Orthogonal Technique.
* Bioenergetic Synchronization Technique.
* Biogeometric Integration.
* Blair Technique.
* Bowen Technique.
* Chiropractic Biophysics Technique.
* Coccygeal Meningeal Stress Fixation Technique.
* ConnecTX (an instrument-assisted connective tissue therapy
				  program).
* Cranial Manipulation.
* Directional Non-Force Technique.
* FAKTR (Functional and Kinetic Treatment with Rehab)
				  Approach.
* Gonzalez Rehabilitation Technique.
* Inertial traction (inertial extensilizer decompression
				  table.
* IntraDiscNutrosis program.
* Koren Specific Technique.
* Manipulation for infant colic.
* Manipulation for internal (non-neuromusculoskeletal)
				  disorders (Applied Kinesiology).
* Manipulation Under Anesthesia.
* Moire Contourographic Analysis.
* Network Technique.
* Neural Organizational Technique.
* Neuro Emotional Technique.
* Positional Release Therapy.
* Sacro-Occipital Technique.
* Spinal Adjusting Devices (ProAdjuster, PulStarFRAS,
				  Activator).
* Therapeutic (Wobble) Chair.
* Upledger Technique and Cranio-Sacral Therapy.
* Webster Technique (for breech babies).
* Whitcomb Technique.