CMM-201: Facet Joint Injections/Medial Branch Blocks

Diagnostic facet joint injections/medial branch blocks are covered to confirm reproducible facet-mediated neck or low‑back pain that has failed ≥4 weeks of conservative therapy, with no untreated radiculopathy or other imaging-identified cause; coverage is limited to up to two diagnostic blocks (a second only if the first is positive and performed ≥1 week later), no more than three levels per session, and bilateral same-level injections allowed. Subsequent/therapeutic injections and ultrasound‑guided injections are considered experimental/investigational and not covered, same‑day other spinal injections in the same region and routine IV sedation are not medically necessary, and thorough documentation (provocative testing, conservative care, percent/duration of relief, planned RFA if positive, levels injected, imaging guidance) is required.

"Facet joint injections/medial branch blocks are considered medically necessary for facet mediated pain resulting from disease, injury or surgery and confirmed by provocative testing resulting in re..."