CMM-201: Facet Joint Injections/Medial Branch Blocks

Covered: Facet joint injections/medial branch blocks (C2‑C3 to L5‑S1) are medically necessary as diagnostic (initial + one confirmatory), as therapeutic only when radiofrequency ablation (RFA) is contraindicated, and for intra‑articular synovial cyst aspiration; excluded are ultrasound‑guided procedures, biologic injectates, L5‑S1 injections for SI‑joint pain, >2 diagnostic blocks per level, and injections of >3 contiguous levels. Key requirements: procedures must use fluoroscopic/CT guidance, document ≥3 months of axial pain refractory to ≥4 weeks conservative care with imaging excluding other causes, show ≥80% relief on diagnostic blocks to confirm (two positive blocks required to qualify for therapeutic when RFA is contraindicated), subsequent therapeutic injections require ≥50% relief for ≥12 weeks and be ≥6 months apart, and RFA must be under consideration.

"A diagnostic facet joint injection/medial branch block may be performed to determine whether spinal pain originates in the facet joint or nerves innervating the facet joint (with fluoroscopic or CT..."