Billing and Coding: Facet Joint Interventions for Pain Management

Facet joint diagnostic and therapeutic injections (CPT 64490-64495) and neurolytic/thermal denervation procedures (CPT 64633-64636) are covered for cervical/thoracic and lumbar/sacral facet-mediated pain when reasonable and necessary and documented per LCD L33930, and image guidance (fluoroscopy or CT) is required. Coverage limits include a maximum of four sessions per region per rolling 12 months for CPT 64490-64494 (including when KX is used) and two sessions per region per rolling 12 months for CPT 64633-64636; ultrasound guidance and routine use of anesthesia for injections are not covered. Detailed medical record documentation (assessment, history, signed notes, supporting ICD-10-CM, pain scales, and justification if RFA is not appropriate) and correct modifier/CPT reporting are required for payment.

"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 b..."