Intraosseous Basivertebral Nerve Ablation (L39642) - R1 - Effective January 28, 2024

Date Posted: November 6, 2025

This Local Coverage Determination (LCD) has been revised under contractor numbers: 01112 (NCA), 01182 (SCA), 01212 (AS, GU, HI, and NMI), and 01312 (NV).

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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Last Updated Nov 06 , 2025