Peripheral nerve ablation for limb pain

Peripheral nerve ablation is used to destroy sensory nerve tissues that transmit pain signals from the affected area to the brain. Several nerve ablation techniques are used to manage limb pain, including radiofrequency ablation, cryo-ablation, chemical ablation and surgical ablation. However, the evidence on effectiveness and safety of these techniques to treat limb pain is insufficient.

Coverage decision: Not Covered (Effective date: September 1, 2019)

Peripheral nerve ablation, using any technique, to treat limb pain including for knee, hip, foot, or shoulder due to osteoarthritis or other conditions, is not a covered benefit for adults and children.

The decision is based on a Health Technology Clinical Committee (HTCC) coverage determination finalized on May 17, 2019. The HTCC reviewed the evidence on the technology in January 2019. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that the technology is not a covered benefit. Complete information on this HTCC determination is available here: http://www.hca.wa.gov/about-hca/health-technology-assessment/health-technology-reviews.

In adopting this HTCC coverage determination, the Department has concluded that the determination does not conflict with any state statute. Any coverage for investigational treatment would be considered per WAC 296-20-02850.  Any coverage for health technologies that have a FDA Humanitarian Device Exemption status would be considered per RCW 70.14.120 (1) (b).

Regulatory authority and related information

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