Facet Joint Interventions for Pain Management L38801 - R3 and Billing and Coding: Facet Joint Interventions for Pain Management A58403 - R5 - Effective July 7, 2024

Date Posted: August 1, 2024

This Local Coverage Determination (LCD) has been revised under contractor numbers: 01111 (CA), 01211 (AS, GU, HI, NMI), 01311 (NV), and 01911 (CA, HI & Territories).

Medicare Coverage Database (MCD) Number: L38801 and A58403

Effective Date: July 7, 2024

Summary of Changes to the LCD:

Updated "Coverage Indications, Limitations and/or Medical Necessity" with the following:

  • B. Therapeutic Facet Joint Procedures (IA or MBB) - removed (IA) under Frequency Limitations.
  • Limitations #9 - removed, "intraarticular"

Summary of Changes to the Billing and Coding article:

  • Added verbiage under Coding Guidance.
  • Added ICD-10-CM codes M53.82, M53.83, M53.84, M53.85, M53.86, and M53.87 to ICD-10-CM Codes that Support Medical Necessity Group 1.
  • Added Group 1: Medical Necessity ICD-10-CM Codes Asterisk Explanation: To be used for facet cyst.

Visit the Noridian Active LCDs webpage or the CMS MCD to view the entire LCD and Billing and Coding article.

Last Updated Aug 01 , 2024