Facet Joint Interventions for Pain Management L38803 - R3 and Billing and Coding: Facet Joint Interventions for Pain Management A58405 - R5 - Effective July 7, 2024

Date Posted: August 1, 2024

This Local Coverage Determination (LCD) has been revised under contractor numbers: 02101 (AK), 02201 (ID), 02301 (OR), 02401 (WA), 03101 (AZ), 03201 (MT), 03301 (ND), 03401 (SD), 03501 (UT), and 03601 (WY).

Medicare Coverage Database (MCD) Number: L38803 and A58405

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