Facet Joint Interventions for Pain Management

Facet joint interventions (diagnostic IA/MBB, therapeutic IA/MBB, RFA, and cyst aspiration) are covered for adults with chronic (>=3 months) moderate-to-severe axial neck or low back pain causing functional deficit, after failed conservative care and no alternative non-facet etiology. Diagnostic confirmation generally requires two diagnostic blocks each with >=80% pain relief before RFA or therapeutic injections; therapeutic benefit thresholds are >=50% pain or functional improvement for specified durations. Procedures must be performed with fluoroscopic or CT guidance by credentialed providers, adhere to specified frequency limits (diagnostic ≤4, therapeutic ≤4, RFA ≤2 sessions per spinal region per rolling 12 months), and meet detailed documentation requirements.

"Moderate-to-severe chronic axial neck or low back pain causing functional deficit on a documented pain or disability scale."