Billing and Coding: Facet Joint Interventions for Pain Management

This policy covers diagnostic and therapeutic facet joint interventions (paravertebral facet blocks, intraarticular injections, medial branch blocks, and denervation/RFA) for cervical/thoracic and lumbar/sacral regions when reasonable and necessary per LCD L38801 and AMA CPT guidance, using fluoroscopy or CT image guidance. Coverage includes up to two levels per spine region per session (unilateral or bilateral counted as one level), requires appropriate ICD-10 coding, documentation (assessment, history, test results, signed notes), and use of specified modifiers (KX for diagnostic injections, 50 for bilateral procedures, RT/LT in ASCs); ultrasound guidance, off-label biologics, and routine use of deep sedation/MAC are not covered except when medically justified. Providers must follow AMA CPT, NCCI, and OPPS coding rules and include referring physician NPI when required.

"Diagnostic paravertebral facet joint nerve block, therapeutic intraarticular (facet) injection, medial branch block, and medial branch radiofrequency ablation (neurotomy) are covered for cervical/t..."