Reminder: General Anesthesia and Conscious Sedation is Not Medically Necessary for Facet Joint Interventions

On 4/25/2021 National Government Services revised the Local Coverage Determination L35936 “Facet Joint Interventions for Pain Management” and Local Coverage Article “Billing and Coding: Facet Joint Interventions for Pain Management (A57826)”.

As of 4/25/2021, per the Limitations section of LCD L35936, general anesthesia is considered not reasonable and necessary for facet joint interventions. Neither conscious sedation nor MAC is routinely necessary for intra articular facet joint injections or medial branch blocks and are not routinely reimbursable. Individual consideration may be given on redetermination (appeal) for payment in rare, unique circumstances if the medical necessity of sedation is unequivocal and clearly documented in the medical record. Frequent reporting of these services together may trigger focused medical review.

Posted 6/10/2021