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New Service Added to the Hospital Outpatient Department Prior Authorization Program - Facet Joint Interventions

As a reminder, effective for dates of service rendered on or after 7/1/2023, facet joint interventions are added to the OPD services requiring prior authorization as a condition of payment. On 6/15/2023, National Government Services will begin accepting prior authorization requests for facet joint services.

This new service will be in addition to the existing prior authorization services, which include blepharoplasty, botulinum toxin injection, rhinoplasty, panniculectomy, vein ablation, cervical fusion with disc removal, and implanted spinal neurostimulators. The list of specific HCPCS codes that will be added to the OPD Prior Authorization program for facet joint interventions is listed below.

Prior authorization is a condition of payment and does not change Medicare benefits or coverage requirements. Please visit the Prior Authorization section of our website for details about the prior authorization process.

List of Additional Outpatient Services That Require Prior Authorization

Code Facet Joint Interventions
64490 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level
64491 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level
64492 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s)
64493 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level
64494 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level
64495 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s)
64633 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint
64634 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint
64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint
64636 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint

 

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