It's a good procedure for the right patient. I'm not the best money person to talk to, but I would suggest looking into off label hardware for the Medicare patients if you don't want to send it to your local hospital based docs. There's similar hardware that uses RF energy to create a lesion around that nerve available from the cancer space.
Stryker's Optablate, Medtronic's Osteocool, and Merit Medical's STAR ablation system are all able to do this.
Merit Medical's STAR Ablation system is what I'm using as it's unipedicular/steerable. This is mainly due to approval/training from Intracept but also I use them for complex cancer pain intermittently. It's priced as an add on to a kyphoplasty with a lower CPT code 20982($6,501 for ASC) compared to 64628 ($9,418 for ASC) so margin should be higher in PP. The procedure is mostly the same between the two but a little more technically challenging due to the lack of a sheath to maintain the pathway, and with the harder bone, you'd need to use something like a sponge stick or cast spreaders to help remove the osteotome.
As they're all off-label for the indication, the reps aren't going to be able to help you out beyond providing hardware, so you would need to know your stuff with getting the RF probe to the right space safely.
