LCD ID Number: L34892 Status: A-Approved
LCD Title: Facet Joint Interventions for Pain Management
Geographic Jurisdiction: Pennsylvania Other Jurisdictions
Original Determination Effective Date:
Original Determination Ending Date:
Revision Effective Date:
Revision End Date:
CMS National Coverage Policy:
This LCD supplements but does not replace, modify or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for facet joint interventions for pain management. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and/or scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations and rules for Medicare payment for facet joint interventions for pain management and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site:
- CMS IOM Publication 100-02, Medicare Benefit Policy Manual,
- Chapter 15, Section 50 Drugs and Biologicals
- CMS IOM Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Chapter 1,
- Part 1, Section 30.3 for Acupuncture
- Part 2, Section 150.7 for Prolotherapy, Joint Sclerotherapy, and Ligamentous Injections with Sclerosing Agents
- Part 4, Section 220.1 for Computed Tomography (CT)
- CMS IOM Publication 100-08, Medicare Program Integrity Manual,
- Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCD
Social Security Act (Title XVIII) Standard References:
- Title XVIII of the Social Security Act, Section 1861(s)(2)(K), medical or surgical services provided by a physician, certified nurse-midwife services, qualified psychologist services, and services of a certified registered nurse anesthetist;
- Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
- Title XVIII of the Social Security Act, Section 1862(a), which are other than physicians’ services described by section 1861(s)(2)(K)
- Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.
Code of Federal Regulations (CFR) References:
- CFR, Title 42, Volume 2, Chapter IV, Part 410.74 Physician assistants' services.
- CFR, Title 42, Volume 2, Chapter IV, Part 410.75 Nurse practitioners' services.
- CFR, Title 42, Volume 2, Chapter IV, Part 410.76 Clinical nurse specialists' services.
- CFR, Title 42, Volume 3, Chapter IV, Part 419.22 Hospital services excluded from payment under the hospital outpatient prospective payment system.
- FR, Volume 65, Number 68, Page 18543. April 7, 2000, non-physician providers services, as defined
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