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CNS Extracranial Autonomic denials: what the review data shows
Independent reviewers have decided 24 published cases where an insurer denied CNS Extracranial Autonomic — and they overturned the insurer 62.5% of the time. A denial for CNS Extracranial Autonomic is a starting position, not a final answer.
Published decisions
24
2001–2026
Overturned
62.5%
15 denials reversed
Conditions behind cns extracranial autonomic denials
What insurers denied — and how those fights ended.
| Category | Decisions | Overturned |
|---|---|---|
| Disc Inflam Pain Oth Dorsalgia | 16 | 62.5% |
What the insurer actually argued
Denials fall into different categories, and they don’t succeed equally — so the reason on your letter changes how you should answer it.
| Reason given | Decisions | Overturned |
|---|---|---|
Experimental/Investigational The plan called the treatment unproven. These turn on published evidence, so the appeal is a literature argument. | 15 | 73.3% |
Medical Necessity The plan said the care wasn’t medically necessary. The most common fight, and the most winnable. | 9 | 44.4% |
Typical time to a decision
6 days
Most land between 4 and 13 days
Handled as urgent
58.3%
Expedited when a delay would cause harm
What the reviewers wrote
Excerpts from the independent reviewers’ published findings — the actual reasoning, quoted, not summarised.
Where the denial was overturned
Findings: The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for suprascapular and axillary nerve radiofrequency ablation. A systematic review indicates that radiofrequency-based interventions targeting shoulder innervation can reduce chronic shoulder pain and improve function. Randomized trial data further show that applying radiofrequency energy to the suprascapular nerve distribution can provide clinically meaningful analgesic benefits compared with injection-based approaches in chronic shoulder pain populations. Prospective evidence also shows meaningful improvements in pain and function in appropriately selected patients with low rates of serious complications over follow-up.
Findings: The physician reviewer found that a patient has requested authorization and coverage for Intracept procedure performed at the L5‑S1 vertebrae. The patient presents with a history of axial low back pain and has trialed physical therapy, medication, and home exercises without improvement. The patient previously tried and failed diagnostic medial branch blocks followed by radiofrequency ablation (RFA). A magnetic resonance imaging (MRI) of the lumbar spine revealed Modic changes at L5‑S1. Medical literature reports improvement in pain and function, including reductions in visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, in patients undergoing basivertebral nerve (BVN) ablation.
Where the denial was upheld
Worth reading too — these show what an appeal has to overcome.
Findings: The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for the Intracept procedure for the back at L5-S1. A study found that patients treated with basivertebral nerve (BVN) ablation showed significant improvement in pain and visual analog scale (VAS), which was sustained out to five years. One study reported improved Oswestry Disability Index (ODI) and pain scores with BVN at the three month endpoint. Another study similarly reported improved VAS and ODI in patients who underwent BVN ablation. In addition, the American Society of Pain and Neuroscience (ASPN) guidelines note that BVN ablation has received a Level A grade for high certainty that the net benefit is substantial in appropriately selected patients.
Findings: The physician reviewer found that Nature of Statutory Criteria/Case Summary: A patient has requested authorization and coverage for the Intracept procedure. The medical literature reports significant benefit in pain and function with basivertebral nerve ablation (the Intracept procedure) for patients with axial back pain without radiation. In this case, the record establishes that the patient has a significant history of lower back pain with additional radicular pain. A review of the records establishes repeated mention of the patient’s radicular and sacroiliac pain. Vertebrogenic pain is very specifically axial low back pain without radiation. Additionally, there is no mention of symptoms consistent with vertebrogenic pain, such as worse axial pain with sitting and bending.
Figures and quotations on this page come from 42,749 published decisions in the California DMHC Independent Medical Review dataset. These are California outcomes — every state runs an equivalent external review, but the rates here are California’s. Excerpts are quoted verbatim from the public record and describe this treatment generally, not any individual case.
How to use this in your appeal
These are outcomes from California’s external review program — an independent physician panel that binds the insurer. Every state has an equivalent process, and internal appeals succeed even more often. Cite the outcome record for CNS Extracranial Autonomicwhen you appeal: reviewers routinely find that denials like yours didn’t hold up.
SOURCE: CALIFORNIA DMHC INDEPENDENT MEDICAL REVIEW OUTCOMES (CHHS OPEN DATA) · DERIVED AGGREGATE STATISTICS ONLY · METHODOLOGY
Not legal or medical advice. Coverage Rights is a self-help tool that helps you prepare your own appeal. For advice about your specific situation, talk to a licensed attorney or your doctor.