CMM-201: Facet Joint Injections/Medial Branch Blocks

Diagnostic facet joint injections/medial branch blocks are medically necessary for chronic neck or low back pain suspected to be facet-mediated (excluding untreated radiculopathy except for facet joint synovial cysts) when ≥4 weeks of conservative therapy failed, facet-loading maneuvers reproduce pain, imaging excludes other causes, the motion segment is not posteriorly fused, and the procedure is performed with fluoroscopic or CT guidance (intra‑articular injection with synovial cyst aspiration is allowed if imaging confirms nerve‑root compression). A confirmatory second block at the same level showing ≥80% pain relief for the expected anesthetic duration is required before radiofrequency denervation; therapeutic injections beyond the confirmatory block, ultrasound‑guided injections, non‑approved injectates, same‑day other regional injections, >3 contiguous levels, and injections at fused levels (except specific exceptions) are excluded or considered experimental, and detailed documentation of exam, conservative care, imaging, injectate, image guidance, levels, and pain relief magnitude/duration is required.