Intraosseous Basivertebral Nerve Ablation (L39644) - R1 - Effective January 28, 2024

Date Posted: November 6, 2025

This Local Coverage Determination (LCD) has been revised under contractor numbers: 02102 (AK), 02202 (ID), 02302 (OR), 02402 (WA), 03102 (AZ), 03202 (MT), 03302 (ND), 03402 (SD), 03502 (UT), and 03602 (WY).

Effective Date: January 28, 2024

Summary of Changes:

Typographical corrections were made to the section: Coverage Indications, Contraindications, Medical Necessity, Non-Coverage and Limitations under Limitations.

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