Medicare publishes revised LCD for Facet Joint Interventions for Pain Management, providing coverage for therapeutic facet joint nerve blocks.
As you know, the LCD which went into effect on 5/2/2021, limited its coverage to intraarticular joint injections. When ASIPP became aware of this limited coverage, we began contacting Medicare to request a policy change to include therapeutic facet joint nerve blocks. After several correspondences, we were advised to file a reconsideration request. Our reconsideration request went through the appropriate channels and the LCD has been revised effective 7/7/2024, which includes medial branch blocks as a therapeutic procedure, along with the intraarticular injections.
Once again therapeutic facet joint injections or medial therapeutic facet joint nerve blocks are not covered unless there is justification in the documentation showing why radiofrequency neurotomy cannot be performed.
ASIPP was able to obtain this addition by presenting appropriate evidence with multiple systematic reviews as well as up-to-date literature. A presentation was also made by Dr. Laxmaiah Manchikanti and Dr. Amol Soin at CGS open meeting.
In addition to CGS, all MACs have either changed or are in the process of changing their policies Please see the policy from CGS using the following link. https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=38773
Manchikanti L, Knezevic E, Knezevic NN, et al. Effectiveness of facet joint nerve blocks in managing chronic axial spinal pain of facet joint origin: A systematic review and meta-analysis. Pain Physician 2024; 27:E169-E206. https://pubmed.ncbi.nlm.nih.gov/38324785/
Anshul Malhotra N, Kumar A, Jyotsna, Rohilla K, Sinha N. Comparative evaluation of intraarticular facet joint injection versus medial branch block in patients with low back pain: A randomized controlled study. Cureus 2023; 15:e49232. https://pubmed.ncbi.nlm.nih.gov/38143628/
Manchikanti L, Knezevic E, Knezevic NN, Pasupuleti R, Sanapati MR, Janapala RN, Kaye AD, Hirsch JA. The effectiveness of medial branch blocks and radiofrequency neurotomy in managing chronic thoracic pain: A systematic review and meta-analysis. Pain Physician 2023; 26:413-435. https://pubmed.ncbi.nlm.nih.gov/37774177/
Pasuhirunnikorn P, Tanasansomboon T, Singhatanadgige W, Yingsakmongkol W, Chalermkitpanit P. Comparative outcome of lidocaine versus bupivacaine for cervical medial branch block in chronic cervical facet arthropathy: A randomized double-blind study. World Neurosurg 2023; 175:e662-e668. https://pubmed.ncbi.nlm.nih.gov/37030481/
