Billing and Coding: Facet Joint Interventions for Pain Management

This policy covers diagnostic and therapeutic facet joint interventions (diagnostic nerve blocks, intraarticular injections, medial branch blocks, and medial branch RFA/denervation) in the cervical/thoracic and lumbar/sacral regions when performed with fluoroscopic or CT image guidance, with coding and reporting rules (unit counting, bilateral modifier -50, ASC RT/LT reporting). Coverage excludes ultrasound-guided procedures, injections of non-designated biologics (which will be denied), and routine use of moderate/deep sedation or MAC except when medically necessary for RFA or cyst aspiration with documentation. Claims must include a valid ICD-10 code, referring provider NPI when required, appropriate modifiers (e.g., KX for diagnostic injections, 50 for bilateral), and medical record documentation of assessment, history, test results, and signed visit/operative reports; refer to LCD L38803 for additional reasonable/necessary and frequency details.

"Facet joint interventions (diagnostic nerve block, therapeutic intraarticular injection, medial branch block, and medial branch radiofrequency ablation) are covered when performed in the cervical/t..."