20 Miss. Code R. § 2-XVI
When the following procedures are performed as investigational procedures they will not qualify for reimbursement under the Mississippi Workers' Compensation Medical Fee Schedule:
See below for a list of additional procedures that are not reimbursable when performed as investigational procedures.
* AccuraScope procedure.
* Annulo-nucleoplasty (The Disc-FX procedure).
* Annulus repair devices (Xclose Tissue Repair System, Barricaid, Disc Annular Repair Technology (DART) System).
* BacFast HD for isolated facet fusion.
* Biomet Aspen fusion system (an interlaminar fixation device).
* Cervical intradiscal radiofrequency lesioning.
* Chemical ablation (including but not limited to alcohol, phenol or sodium morrhuate) of facet joints.
* Coblation percutaneous disc decompression.
* Coccygeal ganglion (ganglion impar) block for coccydynia, pelvic pain, and all other indications.
* Cooled radiofrequency ablation for facet denervation.
* Cryoablation (cryoanesthesia, cryodenervation, cryoneurolysis, or cryosurgery) for the treatment of lumbar facet joint pain.
* Deuk Laser Disc Repair.. Devices for annular repair (e.g., Inclose Surgical Mesh System).
* Dynamic (intervertebral) stabilization (e.g., BioFlex, CD Horizon Agile Dynamic Stabilization Device, DSS Dynamic Soft Stabilization System, Dynabolt Dynamic Stabilization System, Dynesys Spinal System, Graf ligamentoplasty/Graf artificial ligament, Isobar Spinal System, NFix, Satellite Spinal System, Stabilimax NZ Dynamic Spine Stabilization System, and the Zodiak DynaMo System).
* Endoscopic disc decompression, ablation, or annular modulation using the DiscFX System.
* Endoscopic laser foraminoplasty, endoscopic foraminotomy, laminotomy, and rhizotomy (endoscopic radiofrequency ablation).
* Endoscopic transforaminal diskectomy.
* Epidural fat grafting during lumbar decompression laminectomy/discectomy.
* Epidural injections of lytic agents (e.g., hyaluronidase, hypertonic saline) or mechanical lysis in the treatment of adhesive arachnoiditis, epidural fibrosis, failed back syndrome, or other indications.
* Epidural steroid injections for the treatment of non-radicular low back pain.
* Epiduroscopy (also known as epidural myeloscopy, epidural spinal endoscopy, myeloscopy, and spinal endoscopy) for the diagnosis and treatment of intractable LBP or other indications.
* Facet chemodenervation/chemical facet neurolysis.
* Facet joint allograft implants (NuFix facet fusion, TruFuse facet fusion).
* Facet joint implantation (Total Posterior-element System (TOPS) (Premia Spine), Total Facet Arthroplasty System (TFAS) (Archus Orthopedics), ACADIA Facet Replacement System (Facet Solutions/Globus Medical).
* Interlaminar lumbar instrumented fusion (ILIF).
* Interspinous and interlaminar distraction devices.
* Interspinous fixation devices (CD HORIZON SPIRE Plate, PrimaLOK SP, SP-Fix Spinous Process Fixation Plate, and Stabilink interspinous fixation device) for spinal stenosis or other indications.
* Intradiscal biacuplasty (IDB)/intervertebral disc biacuplasty/cooled radiofrequency.
* Intradiscal electrothermal annuloplasty (IEA).
* Intradiscal electrothermal therapy (IDET).
* Intradiscal glucocorticoid injection for the treatment of low back pain.
* Intradiscal implantation of combined autologous adipose-derived mesenchymal stem cells and hyaluronic acid for the treatment of discogenic low back pain.
* Intradiscal implantation of stromal vascular fraction plus platelet rich plasma for the treatment of degenerative disc disease.
* Intradiscal infiltration with plasma rich in growth factors for the treatment of low back pain.
* Intradiscal injection of autologous bone marrow concentrate for the treatment of degenerative disc disease.
* Intradiscal injection of platelet-rich plasma.
* Intradiscal methylene blue injection for the treatment of low back pain.
* Intradiscal pulsed radiofrequency for the treatment of discogenic neck pain.
* Intradiscal steroid injections.
* Intradiscal thermal annuloplasty (IDTA).
* Intradiscal, paravertebral, or epidural oxygen or ozone injections.
* Intravenous administration of corticosteroids, lidocaine, magnesium, Toradol or vitamin B12 (cyanocobalamin) as a treatment for back pain and neck pain.
* Khan kinetic treatment (KKT).
* Laser facet denervation.
* Least invasive lumbar decompression interbody fusion (LINDIF).
* Microsurgical lumbar sequestrectomy for the treatment of lumbar disc herniation.
* Minimally invasive endoscopic transforaminal lumbar interbody fusion (endoscopic MITLIF; same as endoscopic MAST fusion) for lumbar disc degeneration and instability or other indications.
* Minimally invasive lumbar decompression (MILD) procedure (percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements under indirect image guidance) for lumbar canall stenosis or other indications.
* Minimally invasive thoracic discectomy for the treatment of back pain.
* Nucleoplasty (also known as percutaneous radiofrequency thermomodulation or percutaneous plasma diskectomy).
* OptiMesh grafting system.
* Percutaneous (or plasma) disc decompression (PDD).
* Percutaneous cervical diskectomy.
* Percutaneous endoscopic diskectomy with or without laser (PELD) (also known as arthroscopic microdiskectomy or Yeung Endoscopic Spinal Surgery System [Y.E.S.S.]).
* Percutaneous intradiscal radiofrequency thermocoagulation (PIRFT)/intradiscal radiofrequency thermomodulation/percutaneous radiofrequency thermomodulation.
* Piriformis muscle resection and other surgery for piriformis syndrome.
* Posterior intrafacet implants (e.g., DTRAX Cervical Cage) for posterior cervical fusion.
* Psoas compartment block for lumbar radiculopathy or myositis ossification.
* Racz procedure (epidural adhesiolysis with the Racz catheter) for the treatment of members with adhesive arachnoiditis, epidural adhesions, failed back syndrome from multiple previous surgeries for herniated lumbar disk, or other indications.
* Radiofrequency annuloplasty (RA).
* Radiofrequency denervation for sacroiliac joint pain.
* Radiofrequency lesioning of dorsal root ganglia for back pain.
* Radiofrequency lesioning of terminal (peripheral) nerve endings for back pain.
* Radiofrequency/pulsed radiofrequency ablation of trigger point pain.
* Sacroiliac fusion or pinning for the treatment of LBP due to sacroiliac joint syndrome; Note: Sacroiliac fusion may be medically necessary for sacroiliac joint infection, tumor involving the sacrum, and sacroiliac pain due to severe traumatic injury where a trial of an external fixator is successful in providing pain relief.
* Sacroiliac joint fusion (e.g., by means of the iFuse System and the SImmetry Sacroiliac Joint Fusion System).
* Sacroplasty for osteoporotic sacral insufficiency fractures and other indications.
* Targeted disc decompression (TDD).
* Total Facet Arthroplasty System (TFAS) for the treatment of spinal stenosis.
* Vesselplasty (e.g., Vessel-X).
The following chiropractic procedures are considered experimental and investigational and therefore, do not qualify for reimbursement under the Mississippi Workers' Compensation Medical Fee Schedule.
* Active Release Technique.
* Active Therapeutic Movement (ATM2).
* Advanced Biostructural Correction (ABC) Chiropractic Technique.
* Applied Spinal Biomechanical Engineering.
* Atlas Orthogonal Technique.
* Bioenergetic Synchronization Technique.
* Biogeometric Integration.
* Blair Technique.
* Bowen Technique.
* Chiropractic Biophysics Technique.
* Coccygeal Meningeal Stress Fixation Technique.
* ConnecTX (an instrument-assisted connective tissue therapy program).
* Cranial Manipulation.
* Directional Non-Force Technique.
* FAKTR (Functional and Kinetic Treatment with Rehab) Approach.
* Gonzalez Rehabilitation Technique.
* Inertial traction (inertial extensilizer decompression table.
* IntraDiscNutrosis program.
* Koren Specific Technique.
* Manipulation for infant colic.
* Manipulation for internal (non-neuromusculoskeletal) disorders (Applied Kinesiology).
* Manipulation Under Anesthesia.
* Moire Contourographic Analysis.
* Network Technique.
* Neural Organizational Technique.
* Neuro Emotional Technique.
* Positional Release Therapy.
* Sacro-Occipital Technique.
* Spinal Adjusting Devices (ProAdjuster, PulStarFRAS, Activator).
* Therapeutic (Wobble) Chair.
* Upledger Technique and Cranio-Sacral Therapy.
* Webster Technique (for breech babies).
* Whitcomb Technique.
20 Miss. Code. R. § 2-XVI