Source library
Every packet uses one checked rule per service
Each card names the public Medicare rule we use and the date we last checked it. The wording is ours. Your physician reviews every packet before signing.
Epidural steroid injections
Medicare rule L36920- Pain for 4 weeks or more.
- 4 weeks of therapy or medicine did not help.
- MRI, CT or myelogram matches the exam.
- A pain or function score from before the injection.
- Repeat injection: 50% better pain for 3 months, or 50% better function.
Facet nerve procedures
Medicare rule L34892- First ablation: two test nerve blocks, each with 80% or more relief.
- Repeat ablation: the last one gave 50% better pain for 6 months and 50% better function.
- A new version starts 12-06-2026, with the same numbers.
Neck fusion surgery
Medicare rule L39793- Arm pain of 4 out of 10 or more for 12 weeks.
- Therapy or medicine tried and did not help.
- MRI or CT shows narrowing at the level that matches the exam.
- Nerve pressure limits daily life.
- Other causes ruled out.
Texas plan and other commercial denials, including spine MRI or CT, use the plan's own published policy, which your office attaches. We never copy a plan's guideline text into a packet.