Diagnosis: Low Back Pain.
Treatment: Intraosseous Nerve Ablation (Intracept Procedure).

The insurer denied the Intraosseous Nerve Ablation (Intracept Procedure). The denial is upheld.

The patient is an adult male with chronic low back pain in whom an Intracept procedure has been requested. The procedure was denied coverage by the health plan as not medically necessary.

The patient has failed conservative treatment in the form of physical therapy, epidural steroid injections, RFA (radiofrequency ablation), and home exercises. The patient has failed multiple medications. Magnetic resonance image shows degenerative endplate changes, which can be taken to mean Modic changes. The patient's physical exam does not reveal any neurological injury.

The requested Intracept procedure is not medically necessary.

The requested Intracept is not likely to be more beneficial than standard treatments. The patient is an adult male with chronic low back pain in whom an Intracept procedure has been requested. The procedure was denied coverage by the health plan as not medically necessary. The patient has failed conservative treatment in the form of physical therapy, epidural steroid injections, RFA (radiofrequency ablation), and home exercises. The patient has failed multiple medications. Magnetic resonance image shows degenerative endplate changes, which can be taken to mean Modic changes. The patient's physical exam does not reveal any neurological injury. The Intracept procedure (interosseous basivertebral nerve ablation) is not an intradiscal procedure. It is a new Food and Drug Administration (FDA)-approved intraosseous nerve ablation for the treatment of chronic low back pain in the treatment of vertebrogenic related chronic low back pain. It is typically used in patients with significant Modic type 1 or type 2 vertebral endplate changes, typically in situations where conventional and typical options have been exhausted. The procedure is a Food and Drug Administration (FDA)-approved procedure for axial low back pain. It has been shown effective in randomized clinical trials (RCT) with five-year results. However, this patient has not failed or attempted all conventional and typical options for common causes of axial low back pain. The Intracept procedure should be employed after all conventional and evidence-proven alternatives have failed. The literature has not shown superiority over conventional, less invasive treatments, which is the basis to the denial. Given that the alternatives do show favorable outcomes in the literature, have lower risk, and morbidity, the requested Intracept procedure is not medically necessary.