@ericanelson02

TBH I don't have a plan. Next step is another MRI and then one more epidural. If no relief I might be referred to another specialist for a procedure called Intercept which is a type of ablation. If that falls through then maybe treatment for Cluneal nerve.

Anyone had the Intercept procedure? Were there hassles with insurance coverage?
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AI Overview Yes, Medicare covers the Intracept procedure (intraosseous basivertebral nerve ablation) when strict medical necessity criteria are met.Coverage is governed by regional Local Coverage Determinations (LCDs) issued by your Medicare Administrative Contractor (MAC). To qualify for coverage, you must meet all of the following requirements:Pain Duration & Severity: You have experienced chronic low back pain for at least 6 months, and it primarily affects the lower back.Failed Conservative Care: You must have documented failure of at least 3 different non-surgical treatments over a minimum of 6 months (e.g., physical therapy, chiropractic care, prescription medications, or injections).MRI Confirmation: An MRI must show specific changes (Modic Type 1 or Type 2 changes) in the vertebrae located between L3 and S1.Exclusion of Other Causes: Your pain cannot be explained by other structural spinal issues like severe spinal stenosis, tumors, or recent fractures.Additionally, Medicare enforces strict limits on how often the procedure can be performed. It is covered only once per vertebral body per lifetime, with a maximum of 4 vertebral bodies treated in total, and no more than 2 levels treated in a single session.Before proceeding, you should speak with your pain management specialist to ensure all clinical notes, MRI results, and conservative treatment records are properly documented to meet CMS Local Coverage Determinations.
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Cluneal nerve entrapment (or cluneal neuralgia) is treated with a multimodal approach. Treatment typically progresses from conservative physical and medical therapies to minimally invasive procedures and, if necessary, surgery.1. Conservative Treatments (First Line)Physical Therapy: Focuses on myofascial release, soft tissue mobilization, and stretching. It aims to correct poor posture, strengthen the core and lower back, and reduce tension in the thoracolumbar junction.Medications: Over-the-counter NSAIDs (e.g., ibuprofen or naproxen) help reduce localized inflammation. Neuropathic pain agents (like gabapentin or pregabalin) may be prescribed to calm irritated nerves.2. Minimally Invasive InterventionsDiagnostic & Therapeutic Nerve Blocks: Injections containing local anesthetics and corticosteroids are placed around the nerve (often under ultrasound guidance) to simultaneously confirm the diagnosis and provide relief.Radiofrequency Ablation (RFA): Uses thermal energy to temporarily disrupt the sensory pain signals from the cluneal nerves, providing longer-lasting relief.Neuromodulation: Wireless peripheral nerve stimulation may be used to block pain signals before they reach the brain.3. Surgical OptionsNerve Decompression: If conservative and interventional methods fail, surgical release (or minimally invasive endoscopic decompression) can free the nerve from surrounding scarred or tight tissues.Nerve Disconnection: In certain cases, a specialized spinal or peripheral nerve surgeon may sever the small, purely sensory cluneal branches to permanently disable the pain pathway.