Facet Joint Interventions for Pain Management
L35936
Facet joint interventions (diagnostic IA/MBB, therapeutic IA/MBB, RFA, and facet cyst aspiration/rupture) are covered for chronic axial neck or low back pain when pain is >=3 months, refractory to conservative care, no alternative non-facet pathology is present, and required diagnostic response thresholds are met (diagnostic blocks with >=80% relief). Imaging guidance (fluoroscopy or CT) and documented pain/disability scales are required; limits include per-region session caps (diagnostic max 4, therapeutic max 4, RFA max 2 per rolling 12 months), level limits (1–2 levels per session), and exclusions such as non-guided procedures, non-thermal denervation methods, routine use of sedation/GA for most procedures, and procedures for generalized/centralized pain syndromes.
"Moderate to severe chronic axial neck or low back pain causing functional deficit on a documented pain or disability scale, present for >=3 months and refractory to noninvasive conservative managem..."