joint sclerotherapy, and ligamentous injections with sclerosing agent are not a
covered benefit. These therapies are not generally accepted as medically
necessary treatments. Their medical effectiveness has not been verified by
scientifically controlled studies and, therefore, is considered investigational
Investigational treatments are a specific exclusion in all of our plan
documents; therefore these therapies are considered to be contract exclusion.
Note: There is no Hayes
technology assessment of Prolotherapy available. However, the HCPCS book lists
M0076 as a non-covered code.
Codes Used In This BI: