CMM-201: Facet Joint Injections/Medial Branch Blocks

Diagnostic facet joint injections/medial branch blocks are covered to evaluate chronic neck or low‑back pain (not for untreated radiculopathy) and intra‑articular injection with synovial cyst aspiration is covered for imaging‑confirmed nerve‑root–compressing cysts, while ultrasound guidance, injections at posteriorly fused segments, same‑day regional injections, >3 levels/session, and therapeutic/repeat injections (except one confirmatory block or narrow repeat scenarios) are excluded or considered experimental. Key requirements: documentation of pain provoked by facet‑loading, ≥4 weeks of conservative treatment (or documented contraindication), imaging excluding other causes, fluoroscopic/CT guidance, ≤3 levels treated, a diagnostic block is “positive” only with ≥80% pain relief for the anesthetic duration, a second confirmatory block must be at the same level and only if radiofrequency ablation is being considered, and limited repeat injections require prior >50% relief for ≥12 weeks, not being an RFA candidate, and ≥6 months since the prior injection.