Facet Joint Interventions for Pain Management

Facet joint interventions (diagnostic MBB/IA, therapeutic injections, RFA, and cyst aspiration) are covered for patients with chronic (>=3 months) moderate-to-severe axial neck or low back pain causing functional deficit, after failed conservative management, absence of non-facet pathology, and documented diagnostic responses. Diagnostic confirmation requires dual-block methodology with each diagnostic block providing >=80% relief; therapeutic injections and RFA have specified response thresholds (>=50% sustained relief for defined durations) and frequency limits per spinal region; procedures must use fluoroscopic or CT guidance and be performed by credentialed providers with required documentation of pain/disability scores and medical necessity for exceptions.

"Moderate to severe chronic neck or low back pain, predominantly axial, causing functional deficit as measured on a pain or disability scale."