Medicare local coverage
Medicare coverage for Thermal Destruction of the Intraosseous Basivertebral Nerve (BVN) for Vertebrogenic Lower Back Pain (LCD)
2 Medicare Administrative Contractors publish a local coverage determination (LCD) for Thermal Destruction of the Intraosseous Basivertebral Nerve (BVN) for Vertebrogenic Lower Back Pain. The snapshot lists 2 LCD records: 2 active.
An LCD applies only in the jurisdiction of the contractor that wrote it. Two contractors can cover the same service with different criteria, documentation requirements and covered diagnoses, so check the LCD from the contractor that processes your claims.
LCDs by contractor
| Contractor | LCD | Status | Last updated |
|---|---|---|---|
Palmetto GBAMAC - Part A, MAC - Part B | L39420 | Active | Jan 13, 2023 |
Wellpoint FederalMAC - Part A, MAC - Part B | L40302 | Active | Jul 16, 2026 |
An LCD marked Future has been finalized and is in its notice period; it applies from the effective date shown. LCD IDs link to the record on cms.gov.
Billing and coding articles
The codes live in the billing and coding article that goes with each LCD: the CPT and HCPCS codes the policy applies to, the ICD-10 codes that support medical necessity, and any modifier or documentation rules.
CMS also lists 2 response-to-comments articles for this topic, where contractors answer public comments on the proposed LCD: A59297, A60430.
Check claim lines against Medicare coverage
Coverage Check tells you whether a claim's diagnoses support Medicare LCD or NCD coverage for each procedure line, and shows the policy and CMS source behind each answer.
Related LCD topics
- Intraosseous Basivertebral Nerve Ablation
- Nerve Blockade for Treatment of Chronic Pain and Neuropathy
- Percutaneous minimally invasive fusion/stabilization of the sacroiliac joint for the treatment of back pain
- Peripheral Nerve Injections and Procedures for Chronic Pain
- Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds
- Application of Skin Substitute Grafts for Treatment of DFU and VLU of Lower Extremities
All Medicare LCD topics · National coverage determinations · Payer policies by payer
Source: CMS Medicare Coverage Database, via the public CMS Coverage API, snapshot Oct 25, 2026. LCDs change between snapshots; confirm the version in effect for your date of service on cms.gov before billing.