Diagnosis: Complex Regional Pain Syndrome status post Sports Injury.
Treatment: Inpatient Rehabilitation Services.
The insurer denied: Inpatient Rehabilitation Services.
The denial is overturned.

The patient is an adolescent female with complex regional pain syndrome (CRPS). Her pain developed following a sports-related fall. The patient underwent course of physical therapy and has been subjected to additional diagnostic work up including MRI (magnetic resonance imaging) scan and epidural injections provided by the pain management specialist.

The patient was diagnosed with CRPS (complex regional pain syndrome) in earlier this year. Following additional physical therapy, the patient has been recommended to undergo additional pediatric pain management program, including use of spinal cord stimulator due to recurrent progression of pain in the right knee.

The requested health service is medically necessary.

Based on the review of medical records, this patient has been subjected to various interventions, including intensive outpatient treatments, which have not led to favorable outcomes in the treatment of her CRPS (complex regional pain syndrome). Therefore, the patient has been recommended to undergo intensive inpatient treatment where standards of care have been applied in transdisciplinary settings. The extent and frequency of the treatment do not exceed limits, and in fact have been shown to be beneficial for this patient's condition, in both physical and mental aspects.

Therefore, the requested health service is medically necessary.