Facet Joint and Medial Branch Block Injections for Spinal Pain – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers diagnostic facet joint/medial branch blocks only as an initial diagnostic block and one confirmatory block, and considers therapeutic injections (including repeats beyond two at the same level/side), routine intra‑articular steroids, ultrasound‑guided injections, MBB volumes >0.5 mL, and blocks when RFA is not being considered or untreated radiculopathy exists as unproven/not medically necessary. Coverage requires ≥4 weeks failed conservative care with pain ≥3/10, a positive facet‑loading exam, imaging excluding other causes, an unfused motion segment, that radiofrequency ablation is being considered, use of fluoroscopic or CT guidance, and documentation of pain scores, exam/imaging findings, procedure details and a ≥50% pain relief of appropriate duration from the initial block to justify a confirmatory injection.

"Initial diagnostic Facet Joint Injection/Medial Branch Block (FJI/MBB) to determine facet joint origin when ALL of the following criteria are met: pain is exacerbated by facet loading maneuvers on ..."