CMM-201: Facet Joint Injections/Medial Branch Blocks

Cigna/eviCore covers fluoroscopic- or CT‑guided diagnostic facet joint injections/medial branch blocks (C2–C3 to L5–S1) to diagnose facet‑mediated axial cervical/thoracic/lumbar pain or to aspirate synovial cysts causing radiculopathy, limits to two diagnostic blocks per level, allows therapeutic injections only when radiofrequency ablation (RFA) is contraindicated, and excludes ultrasound‑guided procedures, biologic injectates, injections for SI‑joint pain at L5‑S1, >3 levels per session, and more than two diagnostic blocks per level. Key requirements include ≥3 months of axial pain, ≥4 weeks of prior conservative therapy (or documented contraindication), imaging excluding other causes and a non‑posteriorly fused segment, documented ≥80% relief from the first diagnostic block confirmed by a second block at the same level before RFA selection, and specific documentation/timing criteria for therapeutic injections and repeat synovial cyst aspirations (e.g., ≥50% relief for ≥12 weeks and ≥6 months between therapeutic injections).