In episode 13, our experts covered your questions on:

• How does the Centers for Medicare & Medicaid Services (CMS) determine coverage and procedural reimbursement?
• How are LCDs made?
• Who determines the evidence and eventual policy on LCD coverage?
• Are specialists involved in the LCD development and revision process? If yes, how can one become involved?
• Are there other documents besides LCDs necessary for CMS compliance?

Your expert panel for this April 17, 2025 webinar included:

• Meredith Loveless, MD, FACOG, of CGS Administrators where she serves the 48,500 physicians and 2 million Medicare beneficiaries in Kentucky and Ohio as the Chief Medical Officer for the J15 A/B MAC (Medicare Administrative Contractor); and
• W. David Mauck, MD, Chairman of the Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine at Mayo Clinic in Rochester, Minnesota, who also serves IPSIS members as Health Policy Division Chair.

The panel was moderated by Michael Furman, MD, MS, Fellowship Director at OSS Health, who serves on the IPSIS Board as a Member-at-Large, as well as on the IPSIS Education Division, and as Co-Chair of the Education Development Committee. 

Episode 13 Show Notes: These are the Medicare resources and references mentioned on the webinar. We also encourage you to get directly involved in this process. Contact IPSIS Health Policy Director Sarah Cartagena, MS for details.

• What is a MAC and MAC jurisdiction map?
  • What's a MAC | CMS
  • AB-Jurisdiction-Map_03.28.2023
• Local Coverage Determinations
  • Landing page- one stop for all MACs and link to the rules for LCDs
    • Local Coverage Determinations | CMS
  • Medicare Program Integrity Manual (LCD rule MACs must follow)
  • How do I find an LCD? MCD Search
  • LCD request or LCD reconsideration- this should be on your MACs website here is the links for CGS:
    • LCDs & Medical Policies
• Medicare Managed Care Manual Chapter 4 - Benefits and Beneficiary Protections sections 90 – 90.6
  • https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/mc86c04.pdf
  • Do Medicare Advantage Plans Follow CMS Guidelines? | Medicare & Medicare Advantage Info, Help and Enrollment
• How is coverage determined by Medicare?
  • Medicare Coverage Determination Process | CMS this discusses NCD’s as well
  • Article on how evidence is used (CGS): Principles of Study Design
  • How evidence is used published by CMS: CMS National Coverage Analysis Evidence Review
  • The definition of reasonable and necessary for Medicare coverage decisions:
    • Section 1862(2)(a) (1)(A) of the Social Security Act
      • The MAC will determine if an item or service is “reasonable and necessary" under Section 1862(2)(a) (1)(A) of the Act and if the service is:
        • Safe and effective;
        • Not experimental or investigational; and
        • Appropriate, including the duration and frequency in terms of whether the service or item is:
          • Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the beneficiary’s condition or to improve the function of a malformed body member;
          • Furnished in a setting appropriate to the beneficiary’s medical needs and condition;
          • Ordered and furnished by qualified personnel; and
          • One that meets, but does not exceed, the beneficiary’s medical need
  • Top 10 ways providers can impact the LCD process:
    1. LCD request/reconsiderations.
    2. Research! Producing high quality literature to answer questions in evidence-based way.
    3. Sharing pertinent literature with your MAC.
    4. Serving as CAC member or as subject matter expert.
    5. Participating in societies / providing input for societies.
    6. Societies/panels to produce evidence-based guidelines – encourage use of GRADE or systematic evidence review process.
    7. Present at open meeting or submit comments if concerns – back it up with evidence.
    8. Full disclosure of potential bias.
    9. Understand that we are fulfilling requirements determined by law when we follow the policy process.
    10. Participate in education.

Besides this podcast, a video download is also available here.

© 2025 International Pain and Spine Intervention Society – All Rights Reserved Materials presented in this activity have been made available by the International Pain and Spine Intervention Society for educational purposes only.

In episode 13, our experts covered your questions on:

• How does the Centers for Medicare & Medicaid Services (CMS) determine coverage and procedural reimbursement?
• How are LCDs made?
• Who determines the evidence and eventual policy on LCD coverage?
• Are specialists involved in the LCD development and revision process? If yes, how can one become involved?
• Are there other documents besides LCDs necessary for CMS compliance?

Your expert panel for this April 17, 2025 webinar included:

• Meredith Loveless, MD, FACOG, of CGS Administrators where she serves the 48,500 physicians and 2 million Medicare beneficiaries in Kentucky and Ohio as the Chief Medical Officer for the J15 A/B MAC (Medicare Administrative Contractor); and
• W. David Mauck, MD, Chairman of the Division of Pain Medicine, Department of Anesthesiology and Perioperative Medicine at Mayo Clinic in Rochester, Minnesota, who also serves IPSIS members as Health Policy Division Chair.

The panel was moderated by Michael Furman, MD, MS, Fellowship Director at OSS Health, who serves on the IPSIS Board as a Member-at-Large, as well as on the IPSIS Education Division, and as Co-Chair of the Education Development Committee. Listen on the go — make "Ask the Experts" your new go-to podcast! Besides the video, an audio download is also available here.

Episode 13 Show Notes: These are the Medicare resources and references mentioned on the webinar. We also encourage you to get directly involved in this process. Contact IPSIS Health Policy Director Sarah Cartagena, MS for details.

• What is a MAC and MAC jurisdiction map?
  • What's a MAC | CMS
  • AB-Jurisdiction-Map_03.28.2023
• Local Coverage Determinations
  • Landing page- one stop for all MACs and link to the rules for LCDs
    • Local Coverage Determinations | CMS
  • Medicare Program Integrity Manual (LCD rule MACs must follow)
  • How do I find an LCD? MCD Search
  • LCD request or LCD reconsideration- this should be on your MACs website here is the links for CGS:
    • LCDs & Medical Policies
• Medicare Managed Care Manual Chapter 4 - Benefits and Beneficiary Protections sections 90 – 90.6
  • https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/mc86c04.pdf
  • Do Medicare Advantage Plans Follow CMS Guidelines? | Medicare & Medicare Advantage Info, Help and Enrollment
• How is coverage determined by Medicare?
  • Medicare Coverage Determination Process | CMS this discusses NCD’s as well
  • Article on how evidence is used (CGS): Principles of Study Design
  • How evidence is used published by CMS: CMS National Coverage Analysis Evidence Review
  • The definition of reasonable and necessary for Medicare coverage decisions:
    • Section 1862(2)(a) (1)(A) of the Social Security Act
      • The MAC will determine if an item or service is “reasonable and necessary" under Section 1862(2)(a) (1)(A) of the Act and if the service is:
        • Safe and effective;
        • Not experimental or investigational; and
        • Appropriate, including the duration and frequency in terms of whether the service or item is:
          • Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the beneficiary’s condition or to improve the function of a malformed body member;
          • Furnished in a setting appropriate to the beneficiary’s medical needs and condition;
          • Ordered and furnished by qualified personnel; and
          • One that meets, but does not exceed, the beneficiary’s medical need
  • Top 10 ways providers can impact the LCD process:
    1. LCD request/reconsiderations.
    2. Research! Producing high quality literature to answer questions in evidence-based way.
    3. Sharing pertinent literature with your MAC.
    4. Serving as CAC member or as subject matter expert.
    5. Participating in societies / providing input for societies.
    6. Societies/panels to produce evidence-based guidelines – encourage use of GRADE or systematic evidence review process.
    7. Present at open meeting or submit comments if concerns – back it up with evidence.
    8. Full disclosure of potential bias.
    9. Understand that we are fulfilling requirements determined by law when we follow the policy process.
    10. Participate in education.

© 2025 International Pain and Spine Intervention Society – All Rights Reserved Materials presented in this activity have been made available by the International Pain and Spine Intervention Society for educational purposes only.

We answered your questions in this second session of the IPSIS Post-Residency Roadmap with a webinar that focused on the crucial pain medicine program interview. Watch recent fellows describe their experiences and get actionable insights from program directors of both Accreditation Council for Graduate Medical Education (ACGME)-accredited and North American Spine Society (NASS)-recognized fellowships. The panel covered:

• What role does application timing play in getting an interview?
• How do you distinguish yourself as an applicant applying from a different field?
• How do you best prepare for the interview?
• What questions should you ask to gain insight on a program during a virtual interview?
• What are the common interview pitfalls, and how can you avoid them?
• Which type of questions do program directors wish candidates asked more of?
• Do "thank you" notes matter?

Your panel included:

• Gary J. Brenner, MD, PhD, Director, of the ACGME-accredited Massachusetts General Hospital Pain Medicine Fellowship and an Associate Professor at Harvard Medical School.
• Zheyan (Jenny) Chen, MD, PhD, an attending interventional pain physician, anesthesiologist at Oregon Health & Science University (OHSU), who completed both an ACGME-accredited regional anesthesiology fellowship and an ACGME-accredited chronic pain fellowship at OHSU and also serves IPSIS as a member of the Evidence Analysis Committee and on the Early Career Council as an Ambassador to both the Practice Management and Patient Safety Committees.
• Derick Davis, MD, a current pain fellow at Brigham and Women's Hospital.
• Zachary L. McCormick, MD, Vice Chair and Associate Professor in the Department of Physical Medicine and Rehabilitation (PM&R) at the University of Utah, where he serves as the ambulatory Chief Value Officer, Chief of Spine and Musculoskeletal Medicine, and the founding director of the PM&R Spine and Musculoskeletal Research Program. Dr. McCormick is also the founding director of the NASS-recognized University of Utah Interventional Spine and Musculoskeletal Medicine fellowship and serves on the IPSIS Board as Treasurer.

The panel was moderated by Heidi Chen, MD, an Attending Spine Physiatrist at Vanderbilt University Medical Center and Assistant Professor of PM&R at Vanderbilt University Medical School in Nashville, Tennessee, who completed a NASS-recognized fellowship at OSS Health in York, Pennsylvania and serves IPSIS on the Early Career Council Executive Committee. 

Need a hand in getting stated in your program selection? Watch this video designed to help you discover your optimal interventional pain medicine fellowship.

In episode 12, our experts covered your questions on:

• Which procedures benefit from conscious sedation?
• When should a comparative medial branch block (MBB) be used to select patients?
• Should a single MBB precede radiofrequency neurotomy (RFN) procedures?
• Should an anesthetic test dose be part of transforaminal epidural steroid injections (TFESIs)?
• Are we all on the same page when we use terms including ablation, coagulation, neurotomy, and rhizotomy?
• When considering imaging, is the contralateral oblique view superior to the lateral view for cervical interlaminar epidural steroid injections (ILESIs) or for thoracic or lumbosacral ILESIs?
• Is it helpful or necessary to obtain and review cervical MRI for TFESIs and ILESIs?

Your expert panel for this February 19, 2025 webinar included:

• Fred DeFrancesch, MD, of NeuroMuscular Medical Associates in Hammond, Metairie, and Baton Rouge, Louisiana, who also serves on the IPSIS Education Division, Guidelines Committee, and Instructor Development Committee; and
• Patrick H. Waring, MD, of the Pain Intervention Center in Metairie, Louisiana, who also serves on the IPSIS Education Division, Standards Division, and Guidelines Committee

The panel is moderated by Michael Furman, MD, MS, Fellowship Director at OSS Health, who serves on the IPSIS Board as a Member-at-Large, as well as on the IPSIS Education Division, and as Co-Chair of the Education Development Committee.

Episode 12 Show Notes: These are the abstracts referenced by our experts.

• Cohen SP et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med 2020; 0: pp. 1-44.
• Gharibo C et al. Conus medullaris infarction after a right L4 transforaminal epidural steroid injection using dexamethasone. Pain Physician 2016; 19: E1211-E1214.
• Hurley RW et al. Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group. Pain Med 2021; 22(11): pp. 2443-2523.
• Levi D et al. Safety of dexamethasone in transforaminal epidural steroid injections: A case of temporary paraplegia caused by injection of lidocaine and dexamethasone into a lumbar radiculomedullary artery, with no neurologic sequelae. Interventional Pain.
• Rathmell JP et al. Safeguards to prevent neurologic complications after epidural steroid injections. Anesthesiology 2015; 122: pp.974-84.
• Waring PH et al. Correcting the nomenclature of medial branch neurotomy to medial branch coagulation. Pain Med 2022; 23(3):603-4.

Listen on the go — make "Ask the Experts" your new go-to podcast! Besides the video, an audio download is also available here.

© 2025 International Pain and Spine Intervention Society – All Rights Reserved Materials presented in this activity have been made available by the International Pain and Spine Intervention Society for educational purposes only.

In episode 12, our experts covered your questions on:

• Which procedures benefit from conscious sedation?
• When should a comparative medial branch block (MBB) be used to select patients?
• Should a single MBB precede radiofrequency neurotomy (RFN) procedures?
• Should an anesthetic test dose be part of transforaminal epidural steroid injections (TFESIs)?
• Are we all on the same page when we use terms including ablation, coagulation, neurotomy, and rhizotomy?
• When considering imaging, is the contralateral oblique view superior to the lateral view for cervical interlaminar epidural steroid injections (ILESIs) or for thoracic or lumbosacral ILESIs?
• Is it helpful or necessary to obtain and review cervical MRI for TFESIs and ILESIs?

Your expert panel for this February 19, 2025 webinar included:

• Fred DeFrancesch, MD, of NeuroMuscular Medical Associates in Hammond, Metairie, and Baton Rouge, Louisiana, who also serves on the IPSIS Education Division, Guidelines Committee, and Instructor Development Committee; and
• Patrick H. Waring, MD, of the Pain Intervention Center in Metairie, Louisiana, who also serves on the IPSIS Education Division, Standards Division, and Guidelines Committee

The panel is moderated by Michael Furman, MD, MS, Fellowship Director at OSS Health, who serves on the IPSIS Board as a Member-at-Large, as well as on the IPSIS Education Division, and as Co-Chair of the Education Development Committee.

Episode 12 Show Notes: These are the abstracts referenced by our experts.

• Cohen SP et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med 2020; 0: pp. 1-44.
• Gharibo C et al. Conus medullaris infarction after a right L4 transforaminal epidural steroid injection using dexamethasone. Pain Physician 2016; 19: E1211-E1214.
• Hurley RW et al. Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group. Pain Med 2021; 22(11): pp. 2443-2523.
• Levi D et al. Safety of dexamethasone in transforaminal epidural steroid injections: A case of temporary paraplegia caused by injection of lidocaine and dexamethasone into a lumbar radiculomedullary artery, with no neurologic sequelae. Interventional Pain.
• Rathmell JP et al. Safeguards to prevent neurologic complications after epidural steroid injections. Anesthesiology 2015; 122: pp.974-84.
• Waring PH et al. Correcting the nomenclature of medial branch neurotomy to medial branch coagulation. Pain Med 2022; 23(3):603-4.

Listen on the go — make "Ask the Experts" your new go-to podcast! Besides this podcast, a video download is also available here.

© 2025 International Pain and Spine Intervention Society – All Rights Reserved Materials presented in this activity have been made available by the International Pain and Spine Intervention Society for educational purposes only.

In episode 11, our experts covered your questions on:

• Which vascular structures, nerves, and musculoskeletal structures are best visualized with US?
• Which interventional procedures can be performed with greater efficacy and safety with US guidance?
• Which procedures can be performed exclusively with US guidance, and which benefit from hybrid fluoroscopic/US modalities?
• What are the best ways for pain physicians to get up to speed on utilizing US?
• What tips can help those already utilizing US take their skills to the next level?

Your expert panel for this December 5, 2024 webinar included:

• Lauren A. Chambers, DO, of the University of Rochester Medical Center in Rochester, New York, who also serves on the IPSIS Ultrasound Committee; and

• Jonathan Kirschner, MD, of the Hospital for Special Surgery in New York, New York, who also serves IPSIS as Chair of the Ultrasound Committee.

The panel is moderated by Michael Furman, MD, MS, Fellowship Director at OSS Health, who also serves on the IPSIS Board as a Member-at-Large.

Listen on the go — make "Ask the Experts" your new go-to podcast! Besides the video, an audio download is also available here.

© 2024 International Pain and Spine Intervention Society – All Rights Reserved Materials presented in this activity have been made available by the International Pain and Spine Intervention Society for educational purposes only.

In episode 11, our experts covered your questions on:

• Which vascular structures, nerves, and musculoskeletal structures are best visualized with US?
• Which interventional procedures can be performed with greater efficacy and safety with US guidance?
• Which procedures can be performed exclusively with US guidance, and which benefit from hybrid fluoroscopic/US modalities?
• What are the best ways for pain physicians to get up to speed on utilizing US?
• What tips can help those already utilizing US take their skills to the next level?

Your expert panel for this December 5, 2024 webinar included:

• Lauren A. Chambers, DO, of the University of Rochester Medical Center in Rochester, New York, who also serves on the IPSIS Ultrasound Committee; and

• Jonathan Kirschner, MD, of the Hospital for Special Surgery in New York, New York, who also serves IPSIS as Chair of the Ultrasound Committee.

The panel is moderated by Michael Furman, MD, MS, Fellowship Director at OSS Health, who also serves on the IPSIS Board as a Member-at-Large.

Listen on the go — make "Ask the Experts" your new go-to podcast! Besides the video, an audio download is also available here.

© 2024 International Pain and Spine Intervention Society – All Rights Reserved Materials presented in this activity have been made available by the International Pain and Spine Intervention Society for educational purposes only.

Watch the members-only free Post Residency Roadmap Q&A webinar designed to help you find and secure your optimal interventional pain medicine fellowship and find out:

• What are the secrets to building an unstoppable candidacy for an Accreditation Council for Graduate Medical Education (ACGME)-accredited fellowship?
• How do residents best position themselves for North American Spine Society (NASS)-recognized Interventional Spine and Musculoskeletal Medicine (ISMM) fellowships?
• To what degree are participating in research, publishing papers, and presenting at conferences important to successful fellowship applications?
• What critical moves should you be making if applying this season, next season, in two years?
• How do successful fellows prepare for the interview cycle?
• How do you know which fellowship is right for you?

Your panel includes:

• Heidi Chen, MD, an Attending Spine Physiatrist at Vanderbilt University Medical Center and Assistant Professor of PM&R at Vanderbilt University Medical School in Nashville, Tennessee, who completed a NASS-recognized fellowship at OSS Health in York, Pennsylvania and serves IPSIS on the Early Career Council Executive Committee;
• Qing Zhao Ruan, MD, an Attending Interventional Pain Physician, Anesthesiologist at Providence VA Medical Center, who completed an ACGME-accredited fellowship at Weill Cornell Medicine, New York Presbyterian Hospital, in New York, New York; and
• Kevin Vu, MD, who is currently in an ACGME-accredited pain medicine fellowship at Brigham and Women’s Hospital in Boston, Massachusetts and also serves IPSIS on the Early Career Council as an Ambassador.

The panel is moderated by Christopher Robinson, MD, PhD, who is currently in an ACGME-accredited pain medicine fellowship at Brigham and Women’s Hospital in Boston, Massachusetts and also serves IPSIS on the Early Career Council Executive Committee.

© 2024 International Pain and Spine Intervention Society – All Rights Reserved Materials presented in this activity have been made available by the International Pain and Spine Intervention Society for educational purposes only.

In episode 10, our experts covered your questions on:

• What does the latest research tell us about knee, shoulder, and hip joint denervation?
• What protocol is recommended for identifying and treating pain with knee and other joint denervations
• Should we consider denervation before or after joint replacement, peripheral stimulation, or orthobiologic therapy in our protocol?
• Which modality provides the most effective image guidance – fluoroscopy or ultrasound – and can or should they be combined?
• Do enhanced lesioning treatments utilizing cooled radiofrequency, bipolar, and or multi-tined radiofrequency probes improve outcomes?
• Is phenol neurolysis comparable to radiofrequency denervation, and if so, what phenol volume and concentration should be used?
• Are hip and shoulder denervation comparable to knee denervation on a risk vs benefit basis?

Your expert panel for this October 10, 2024 webinar included:

• Christine Hunt, DO, MS, of the Mayo Clinic in Jacksonville, Florida, who also serves IPSIS as Vice-Chair of the Evidence Analysis Committee; and
• Ameet Nagpal, MD, MS, MEd, MBA, of the Medical University of South Carolina College of Medicine, who also serves IPSIS as Chair of the Guidelines Committee.

The panel was moderated by Michael Furman, MD, MS, Fellowship Director at OSS Health, who also serves on the IPSIS Board as a Member-at-Large.

Episode 10 Show Notes: These are the abstracts referenced by our experts.

• Anatomical Study of the Innervation of Anterior Knee Joint Capsule: Implication for Image-Guided Intervention
• Cooled Radiofrequency Ablation of the Articular Sensory Branches of the Obturator and Femoral Nerves using Fluoroscopy and Ultrasound Guidance: A Large Retrospective Study
• Genicular nerve radiofrequency ablation for the treatment of chronic knee joint pain: a real-world cohort study with evaluation of prognostic factors
• Radiofrequency ablation of the hip: review
• Shoulder Ablation Approaches
• Terminal Sensory Articular Nerve Radiofrequency Ablation for the Treatment of Chronic Intractable Shoulder Pain: A Novel Technique and Case Series

You can also watch the video of this webinar here.

© 2024 International Pain and Spine Intervention Society – All Rights Reserved
Materials presented in this activity have been made available by the International Pain and Spine Intervention Society for educational purposes only.

In episode 10, our experts covered your questions on:

• What does the latest research tell us about knee, shoulder, and hip joint denervation?
• What protocol is recommended for identifying and treating pain with knee and other joint denervations
• Should we consider denervation before or after joint replacement, peripheral stimulation, or orthobiologic therapy in our protocol?
• Which modality provides the most effective image guidance – fluoroscopy or ultrasound – and can or should they be combined?
• Do enhanced lesioning treatments utilizing cooled radiofrequency, bipolar, and or multi-tined radiofrequency probes improve outcomes?
• Is phenol neurolysis comparable to radiofrequency denervation, and if so, what phenol volume and concentration should be used?
• Are hip and shoulder denervation comparable to knee denervation on a risk vs benefit basis?

Your expert panel for this October 10, 2024 webinar included:

• Christine Hunt, DO, MS, of the Mayo Clinic in Jacksonville, Florida, who also serves IPSIS as Vice-Chair of the Evidence Analysis Committee; and
• Ameet Nagpal, MD, MS, MEd, MBA, of the Medical University of South Carolina College of Medicine, who also serves IPSIS as Chair of the Guidelines Committee.

The panel is moderated by Michael Furman, MD, MS, Fellowship Director at OSS Health, who also serves on the IPSIS Board as a Member-at-Large.

Episode 10 Show Notes: These are the abstracts referenced by our experts.

• Anatomical Study of the Innervation of Anterior Knee Joint Capsule: Implication for Image-Guided Intervention
• Cooled Radiofrequency Ablation of the Articular Sensory Branches of the Obturator and Femoral Nerves using Fluoroscopy and Ultrasound Guidance: A Large Retrospective Study
• Genicular nerve radiofrequency ablation for the treatment of chronic knee joint pain: a real-world cohort study with evaluation of prognostic factors
• Radiofrequency ablation of the hip: review
• Shoulder Ablation Approaches
• Terminal Sensory Articular Nerve Radiofrequency Ablation for the Treatment of Chronic Intractable Shoulder Pain: A Novel Technique and Case Series

Listen on the go — make "Ask the Experts" your new go-to podcast! Besides the video, an audio download is also available here.

© 2024 International Pain and Spine Intervention Society – All Rights Reserved Materials presented in this activity have been made available by the International Pain and Spine Intervention Society for educational purposes only.