Prior Authorization (PA) for Facet Joint Intervention

Effective for dates of service beginning July 1, 2023, CMS has added a new service category to the Hospital Outpatient Department (OPD) Prior Authorization program. This additional hospital OPD service category will require prior authorization as a condition of payment for facet joint interventions. CPT codes include the range of 64490-64495 and 64633-64636 when performed in a hospital OPD place of service 19 (off-campus outpatient hospital) or 22 (on-campus outpatient hospital).

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.

Introductory letters will be mailed during the month of May 2023, to providers currently billing for facet joint interventions in hospital OPDs.


Other services already included in the Prior Authorization program for certain hospital OPD services:

CMS Prior Authorization for Certain Hospital OPD Services

Prior Authorization for Certain Hospital Outpatient Department (OPD) Services

Change Request (CR) 13016

            Last Updated Tue, 14 Feb 2023 13:27:24 +0000