Billing and Coding: Facet Joint Interventions for Pain Management

This policy covers cervical/thoracic and lumbar/sacral facet joint interventions (diagnostic blocks, therapeutic intraarticular injections, medial branch blocks, radiofrequency ablation, and chemodenervation) when they meet the reasonable and necessary requirements of LCD L38841 and are performed with fluoroscopy or CT guidance. Ultrasound-guided procedures, use of non‑designated biological agents for injections, and routine moderate/deep sedation or MAC for injections are not covered; documentation requirements include a valid ICD‑10 diagnosis, ordering provider assessment, test results, signed visit/operative notes, and specific justifications (e.g., why RFA is not appropriate). Billing must follow CPT sequencing rules, NCCI/OPPS edits, laterality and unit rules (bilateral = modifier 50; chemodenervation coded per joint = 1 unit per joint), and KX modifier rules for diagnostic injections.

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