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ACG
​
h.o.l.M.E.S.

Automated Clinical Guidelines

Interventional Pain Management

Acupuncture
Anthem
Aetna
Acupuncture forChronic Low Back Pain (cLBP)
BlueMich
HN
Cigna
Humana MA
Medicare
MA
UHC MA
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Back Pain - Invasive Procedures
Botulinum Toxins
Continuous Peripheral Nerve Blocks (CPNB)
Dorsal Column Stimulation
Electric Stimulation for Pain, Swelling and Function in a Clinic Setting
Interventional Pain Management
Aetna
Cigna
Cigna
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Transforaminal Epidural Injections
Selective Nerve Root Blocks
& Transforaminal Epidural Steroid Injections
Epidural Injections
Epidural & Selective Nerve RootBlock (SNRB)
Epidural Steroid Injections for Spinal Pain
Epidural Patching
Epidural Steroid Injections for Pain Management excluding facet joint injections (L39015, L33906, L39036, L39240, L39242, L36920, L38994, L39054)
Aetna
FloridaBlue
Cigna
Aetna
Medicare
UHC
Extended Release Opioids
Opioid Days' Supply Limitation
Radiofrequency Joint Ablation/
Denervation
Facet Joint Interventions
Facet Joint Interventions for Pain Management
Facet Joint Injections
Facet Joint Injections/Medial Branch Blocks
Humana
Cigna
FEP
Medicare
FloridaBlue
Cigna
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Facet Joint Injections for Spinal Pain
Implantable Infusion Pumps for Pain or Spasticity
Injection of Morton's neuroma
Injections for Chronic Pain Conditions
Intraosseous Basivertebral Nerve Ablation
Nerve Blockade for Treatment of Chronic Pain & Neuropathy
Nerve Block Injections
UHC
Humana
Humana
Aetna
FloridaBlue
Aetna
Ablative Treatment for Spinal Pain
Monitored Anesthesia Care (MAC)
 Interventional Pain Management Procedures  Adults
Moderate Sedation for Interventional Pain Management Procedures  Adults
Neuroablative Techniques for Chronic Pain
Peripheral Nerve Blocks
Percutaneous Electrical Nerve Stimulation (PENS)
Percutaneous Vertebral Disc & Vertebral Endplate Procedures
UHC
FloridaBlue
Medicare
FloridaBlue
Cigna
Cigna
Humana
Anthem
Post-Herpetic Neuralgia Treatment
Sacroiliac Joint Injections
Aetna
FloridaBlue
Cigna
Spasticity Management
Spinal Cord Stimulation
Spinal Cord Stimulation for Chronic Pain
Spinal Cord & Dorsal Root Ganglion Stimulation
Tendon Sheath & Ligament Injections
Transcutaneous Electric Nerve Stimulation (TENS)
Trigger Point Injections
Aetna
Humana
Anthem
Aetna
Medicare
FloridaBlue
FloridaBlue
Cigna
FloridaBlue
FEP
FloridaBlue
UHC
Minimally Invasive Spine Surgery Procedures  & Trigger Point Injections
Visco-supplementation 
Visco-supplementation 
for Osteoarthritis
Cigna
Humana
Cigna
Aetna
Cigna
Humana Medicaid
Medicare
UHC

Indicates Non-covered Service

Anesthetic & Antiemetic Infusion Pumps

Discogenic

Pain

Treatment

Epidural Adhesiolysis

Headache & Occipital Neuralgia Treatment

Headaches: Invasive Procedures

Intra-oral Appliances for Headaches & Trigeminal Neuralgia

Orthopedic Applications of Stem-Cell Therapy

Aetna
FloridaBlue
Cigna
Aetna
UHC
FloridaBlue
Cigna
Aetna
FloridaBlue
Cigna
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Intravenous Lidocaine for the Management of Chronic Pain

Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation

Surface Scanning & Macro Electromy-ography

Ultrasound Guidance  Trigger Point injections

Visco-

supplements

FloridaBlue
Cigna
Aetna
Cigna
FloridaBlue
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