Twelve organizations band together to preserve coverage of facet injections
November 17, 2009
We are pleased to announce that ASA along with 11 other specialty societies whose members include pain physicians have joined together to maintain coverage for facet joint injection procedures for Medicare beneficiaries in the areas covered by Noridian Administrative Service (NAS). This matter affects physicians and patients in many western and northern plains states. Earlier this year, Noridian posted a draft Local Coverage Determination (LCD) that would have eliminated any and all coverage for lumbar paravertebral facet joint injections, facet joint nerve blocks and denervation procedures. That proposal brought the pain medicine community together, and the societies, which represent over 140,000 physician members, have proposed an alternative to NAS that, if accepted, will preserve coverage of these important services.
The performance of facet procedures has been under intense scrutiny since September 2008 when the Office of Inspector General (OIG) issued a report that cited serious issues involving miscoding and mispayment. The proposal from the specialties includes some limits on the number and frequency of the procedures that may be performed; however, all the specialties agree that this is consistent with expert opinion and evidence currently available in the medical literature and is far better than no coverage at all. The Carrier Medical Directors will review the proposal and determine the final LCD at some point in the future. ASA will continue to keep you informed on developments.
We consider the improved relationship between the various specialties representing pain physicians to be a welcome development and one that will serve our patients and our members well in the future.
For more information, please use the following links:
ASA opposes adoption of Noridian’s proposed non-coverage of CPT Codes 64622, 64623, 64476, 64476
September 2008 OIG Report
ASA Newsletter, December 2008 Practice Management column