This document addresses cryoneurolysis, a surgical procedure that creates a temporary nerve block through application of extreme cold to the selected site for treatment of various peripheral nerve pain conditions.

Note: Please see the following related documents for additional information:

• CG-SURG-25 Injection Treatment for Morton’s Neuroma
• CG-SURG-89 Radiofrequency Neurolysis and Pulsed Radiofrequency Therapy for Trigeminal Neuralgia
• SURG.00096 Surgical and Ablative Treatments for Chronic Headaches
• SURG.00100 Cryoablation for Plantar Fasciitis and Plantar Fibroma
• SURG.00140 Peripheral Nerve Blocks for Treatment of Neuropathic Pain
• SURG.00142 Genicular Procedures for Treatment of Knee Pain
• SURG.00144 Occipital and Sphenopalatine Ganglion Nerve Block Therapy for the Treatment of Headache and Neuralgia

Position Statement

Investigational and Not Medically Necessary:

Cryoneurolysis is considered investigational and not medically necessary for all indications, including treatment of peripheral nerve pain associated with osteoarthritis of the knee.