Billing and Coding: Facet Joint Interventions for Pain Management

Coverage is allowed for cervical/thoracic and lumbar/sacral facet joint diagnostic and therapeutic interventions when reasonable and necessary per the applicable LCD, and procedures must be performed with fluoroscopy or CT guidance (ultrasound is not covered). Billing is constrained to 1–2 levels per spine region per session with specific CPT code combinations and modifier rules (KX for diagnostic injections, -50/RT/LT for bilateral reporting); documentation requirements include the assessment, relevant history, test results, signed records, referring provider NPI when required, and justification when using sedation or for therapeutic injections in lieu of RFA.

"Facet joint interventions (diagnostic nerve block, therapeutic intraarticular injection, medial branch block, or medial branch radiofrequency ablation/neurotomy) for cervical/thoracic or lumbar/sac..."