New Coverage Policies for Facet Joint Interventions for Pain Management
Mar 26, 2021
In March 2021, Medicare Administrative Contractors (MACs) across all jurisdictions released final local coverage determinations (LCDs) on Facet Joint Interventions for Pain Management,* along with accompanying billing and coding articles that offer additional detailed guidance. Except as shown in the table below, the new LCDs take effect on April 25, 2021.
The LCDs reflect coordinated action across the jurisdictions, with policies largely aligned across all contractors. The LCDs address overall medical reasonableness and necessity 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
Links to each contractor's LCD and associated billing and coding article are provided in the table below. Additional details regarding reasonable and necessary criteria for interventions – along with details on limitations, provider qualifications, and a summary of evidence – can be found in the LCDs, while more detailed information on coding guidance and documentation requirements is included in each contractor's billing and coding article. Please review the guidance in the links for your contractor(s) to understand what requirements will apply in your jurisdiction(s) when the LCDs take effect.
|Contractor||Jurisdiction||LCD||Billing and Coding Article||Effective Date|
|CGS Administrators, LLC||15||L38773||A58364||5/2/2021|
|First Coast Service Options, Inc.||N||L33930||A57787||4/25/2021|
|National Government Services, Inc.||6, K||L35936||A57826||4/25/2021|
|Noridian Healthcare Solutions, LLC||E||L38801||A58403||4/25/2021|
|Noridian Healthcare Solutions, LLC||F||L38803||A58405||4/25/2021|
|Novitas Solutions, Inc.||H, L||L34892||A56670||4/25/2021|
|Palmetto GBA||J, M||L38765||A58350||4/25/2021|
|Wisconsin Physician Service Insurance Corp||5, 8||L38841||A58477||4/25/2021|
* Until their effective dates, these LCDs are designated as “Future” LCDs.