CMM-201: Facet Joint Injections/Medial Branch Blocks

Initial diagnostic facet joint injections/medial branch blocks are covered for chronic neck or back pain suspected to be facet-mediated when pain is worsened by facet-loading maneuvers, at least 4 weeks of documented conservative therapy has failed, imaging/clinical findings exclude other causes, and the motion segment is not posteriorly fused; a second confirmatory block (at the same level) is covered only if the initial block produced ≥80% relief for the expected anesthetic duration and radiofrequency denervation is being considered, and intra-articular injection with synovial cyst aspiration is covered when imaging documents nerve-root compression with clinical correlation. Excluded/limited: procedures without fluoroscopic/CT guidance (including ultrasound), injections in untreated radiculopathy except synovial cyst cases, therapeutic injections beyond a confirmatory block (considered experimental), same-day other regional injections, injections at fused posterior segments (unless pseudoarthrosis), >3 contiguous levels or >2 injections at the same level, and all covered services require documentation of exam findings, conservative therapy, imaging, guidance used, and pain relief/duration where applicable.