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: 02101 (AK), 02201 (ID), 02301 (OR), 02401 (WA), 03101 (AZ), 03201 (MT), 03301 (ND), 03401 (SD), 03501 (UT), and 03601 (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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Last Updated Nov 06 , 2025