- Change to Roster Claims Information Entry in the Fiscal Intermediary Standard System Direct Data Entry
- Drugs and Biologicals - Coverage and Billing
- Medicare Part B Drug Coverage
- Covered Medicare Part B Drugs/Biologicals
- Self-Administered Drug Exclusion
- Medicare Part B General Billing
- Discarded Drugs/Wastage and JW, JZ Modifier
- Chemotherapy General Infusion Information
- Unlisted Codes for Drugs and Biologicals (J3490, J3590 and J9999)
- Compound Drugs
- Patient-Supplied or Free-of-Charge Drugs
- Prolonged Drug and Biological Infusions Using an External Pump
- Coding for Sinuva™ Claims
- Radiopharmaceutical Reimbursement
- Dermal Injections for Treatment of Facial Lipodystrophy Syndrome
- Factor VIII Billing
- Intravitreal Beovu (Brolucizumab-dbl) Billing
- Proper Billing for LEQVIO® HCPCS Code J1306
- Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview
- Proper Billing for TEZSPIRE™ HCPCS Code J2356
- Proper Billing Units for HCPCS Code J7320
- Providers Performing Facet Joint Injections (CPT Code 64476)
- Skin Substitutes
- Vaccines
- Related Content
Providers Performing Facet Joint Injections (CPT Code 64476)
The OIG released the results of an investigation into facet joint injections. Per the OIG report:
"Facet joint injections are typically performed using radiological guidance (radiographic guidance or live x-ray) to ensure correct needle placement and avoid nerve or other injury. Sometimes, a physician performs the procedure without radiological imaging, which is referred to as a “blind” injection. One study of these “blind” injections concluded that facet joint injections should not be performed without the aid of radiological imaging because of potential risk to the patient and lack of diagnostic accuracy."
Since the utilization of these services has increased by 76 percent and payment for the services has increased by over $200 million dollars in less than three years, facet joint injections have become a service of interest for medical necessity, coding accuracy and compliance with regulatory requirements.
In response to this report, National Government Services is updating the claims processing edits for these services and the coding instructions for the LCD for Pain Management (L28529) to reflect that the accompanying radiological guidance, as required in the LCD, has occurred. Please see “Pain Management—Supplemental Instructions Article (A48042)” for more information.
Institutions and physicians must bill the fluoroscopy/guidance codes on the same claim as the injections. Since ASCs may not bill separately for the fluoroscopy services (which are included in the ASC charge for the injection service), they must append modifier KX to the injection code attesting to the fact that radiological guidance was utilized when the injection was performed.
The full OIG report can be accessed at Medicare Payment for Facet Joint Injection Services. Please also review the Pain Management LCD for other procedures that require radiologic guidance.
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Revised 3/26/2024