Facet Joint Interventions for Pain Management
L38801
Facet joint interventions (diagnostic IA/MBB, therapeutic IA/MBB, RFA, and cyst aspiration) are covered for chronic (≥3 months) moderate-to-severe axial neck or low back pain with documented functional deficit and failure of noninvasive conservative therapy, absence of non-facet pathology, and required imaging guidance. Diagnostic confirmation requires dual blocks with ≥80% relief, therapeutic treatments require prior confirmatory diagnostics and documented inability to undergo RFA (if applicable), and specific frequency limits apply (diagnostic and therapeutic: up to 4 sessions/12 months per region; RFA: up to 2 sessions/12 months per region). Procedures without fluoroscopic/CT guidance, routine sedation/GA for injections, multi-level (3–4) blocks per session, treatments for generalized centralized pain (e.g., fibromyalgia), and several non-thermal or investigational modalities are excluded.
"Moderate to severe chronic axial neck or low back pain causing functional deficit, present for at least 3 months, and failing an adequate trial of noninvasive conservative management."