occipital neuralgia and cervicogenic, cluster and migraine headaches

invasive and one in which the nerves and other surrounding structures are not permanently damaged
(AANS, 2006).
U.S. FOOD AND DRUG ADMINISTRATION
Local Injection Therapy: Various local anesthetics are approved by the FDA for use in diagnostic
and therapeutic nerve blockade. Botulinum toxin-A (BTX-A or BOTOX) is a neurolytic agent that has
also been approved by the FDA for treatment of some conditions. However, BTX-A is not specifically
approved for treatment of cervicogenic headache or occipital neuralgia; the use of BTX-A for these
diagnoses is off-label use. Additional information is available at:
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/Dru
gSafetyInformationforHeathcareProfessionals/ucm070366.htm. (Accessed July 2012).
Radiofrequency Ablation (RFA): RFA is a procedure and, therefore, is not subject to regulation by
the FDA. However, the devices used to perform RFA are regulated by the FDA premarket approval
process. There are numerous devices listed in the FDA 510(k) database approved for use in performing
RFA. Two product codes are dedicated to these devices, one for radiofrequency lesion generators
(GXD) and one for radiofrequency lesion probes (GXI). Additional information is available at:
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm. (Accessed July 2012).
Electrical Stimulation: Electrical stimulation of the occipital nerve for the treatment of occipital
neuralgia and cervicogenic headache is a procedure and, therefore, not subject to regulation by the
FDA; however, the devices used to perform electrical stimulation are regulated via the FDA 510(k)
premarket approval process. The Renew Quattrode ® device received 510(k) approval (K000852) on
January 19, 2001, and the Pisces Quad ® device was approved (K040568) on March 25, 2004.
Additional information is available at:
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm. (Accessed July 2012).
Currently no implantable pulse generator, radiofrequency device, or leads are approved by the FDA for
peripheral occipital nerve stimulation to treat occipital neuralgia or cervicogenic headaches.
APPLICABLE CODES
The codes listed in this policy are for reference purposes only. Listing of a service or device code in
this policy does not imply that the service described by this code is a covered or non-covered health
service. Coverage is determined by the benefit document. This list of codes may not be all inclusive.
CPT ® Code Description
Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline
62281 solutions), with or without other therapeutic substance; epidural, cervical or
thoracic
63185 Laminectomy with rhizotomy; 1 or 2 segments
63190 Laminectomy with rhizotomy; more than 2 segments
64405 Injection, anesthetic agent; greater occipital nerve
Occipital Neuralgia & Headache Page 16 of 24