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Revised Coverage Policies for Facet Joint Interventions for Pain Management

  • FUTURE Local Coverage Determination (LCD)

  • Facet Joint Interventions for Pain Management (L35936)

  • Billing and Coding: Facet Joint Interventions for Pain Management (A57826)

In March 2021, National Government Services along with MACs across all Medicare jurisdictions released final LCDs on Facet Joint Interventions for Pain Management, along with accompanying billing and coding articles that offer additional detailed guidance. 

The adoption of this revised LCD reflects a coordinated action across the MAC jurisdictions, with policies largely aligned across all contractors, based on input from subject matter experts across the country. The LCD addresses the medical necessity and reasonableness of facet joint interventions, with additional requirements and frequency limitations specified for the following types of interventions:

  • Diagnostic facet joint procedures
  • Therapeutic facet joint procedures
  • Facet joint denervation; and
  • Facet cyst aspiration/rupture

This LCD will take effect on 4/25/2021.

To review this LCD and the associated Billing and Coding Guideline, before the effective date of 4/25/2021, visit the Medical Policy section of our website, under View LCDs in Notice or click on the links below after 4/25/2021.

LCD
LCD Number
Billing and Coding Number
Related CPT/HCPCS Codes
Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy
Related terms: Radiofrequency, Neurotomy, pain, cervical, lumbar, thoracic
L35936
A57826
64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636, 64625

Posted 4/1/2021


Last Modified: 4/1/21
Revised Coverage Policies for Facet Joint Interventions for Pain Management
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