Criteria
Coverage is subject to the specific terms of the member's benefit plan.
Policy Application
All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of processing, regardless of service date;
or
All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of service.
Nucleoplasty
Policy Application
All claims submitted under this policy's section will be processed according to the policy effective date and associated revision effective dates in effect on the date of processing, regardless of service date.
Nucleoplasty is considered experimental/investigational and therefore non-covered because the safety and/or effectiveness of this service cannot be established by the available peer-reviewed literature.
Procedure Code
S2348
