0216T — Njx paravert w/us lumb/sac
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- The record must contain the performing provider’s assessment related to the complaint, relevant medical history, results of pertinent tests/procedures, and signed and dated office visit or operative reports.
- The medical record must include a valid ICD-10-CM diagnosis code that best describes the patient’s condition; claims without a valid diagnosis will be returned as incomplete under Section 1833(e).
- All documentation must be legible, include patient identification and dates of service, and bear the legible signature of the physician or NPP responsible for care.
- For therapeutic injection procedures, documentation must explain why the patient is not a candidate for RFA.
Key Coverage Criteria
- Diagnostic or therapeutic injection into the paravertebral facet joint or the nerves innervating that joint for pain management is covered for cervical/thoracic and lumbar/sacral regions when consistent with the LCD.
- Thermal neurolytic destruction (radiofrequency ablation) of nerves innervating facet joints is covered in cervical/thoracic and lumbar/sacral regions per CPT codes 64633–64636 when documentation supports medical necessity.
- Unilateral or bilateral facet interventions are permitted during the same session and a bilateral intervention at the same vertebral level is considered a single level for counting/reporting purposes.
- Diagnostic injections that meet KX modifier criteria (typically the two initial diagnostic injections or additional diagnostic injections at different levels when prior injections were non-diagnostic) are permitted when documented.
- Image-guided (fluoroscopy or CT) single-level facet injections and neurolytic procedures performed with fluoroscopy or CT are covered when documentation supports the procedure codes used.
- Diagnostic or therapeutic paravertebral facet joint injections (CPT 64490-64495) for cervical/thoracic or lumbar/sacral facet-mediated pain are covered when reasonable and necessary and supported by documentation consistent with LCD L33930.
20 Active Policies
A58477 — Billing and Coding: Facet Joint Interventions for Pain Management
J05
L38841 — Facet Joint Interventions for Pain Management
J05
L35936 — Facet Joint Interventions for Pain Management
J06
A57826 — Billing and Coding: Facet Joint Interventions for Pain Management
J06
Related Codes
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