March 22, 2021

Medicare Contractors Release Future Effective LCDs on Facet Joint Interventions

The American College of Radiology® Contractor Advisory Committee (CAC) Network has tracked the development of an updated local coverage determination (LCD) on this topic since May 2020. As of today, all seven Medicare Administrative Contractors (MACs) have released the final LCD, billing & coverage article and the response to comments article on this topic. The policy becomes active on April 25, 2021 for most MACs, and the rest by May 1, 2021. This topic is significant for interventional radiologists and pain management communities.

This policy was developed and adopted by all the MACs and therefore represents equivalent coverage across the states. The lead Contractor Medical Director (CMD) has requested that societies educate members on the new policy and associated billing and coding article. Register  for An Evening Discussion on Facet Joint Intervention for Pain Management (L38773). The event is scheduled for April 14, 2021  and hosted by CGS Administrators, LLC.

We encourage you all to review this policy in-depth to avoid future claim denials. At this time, comments are not being solicited. If key changes are needed to the policy, a reconsideration request can be submitted once the policy is active. The requirements for reconsideration are posted on each MAC's website.

Finalized LCDs on Facet Joint Interventions for Pain Management

MAC Notice Period Start and End Future Effective LCD Billing and Coding Response to Comment Article
CGS Administrators, LLC Start - 3/18/21 End - 5/1/21 L38773 A58364 A58613
First Coast Service Options Start - 3/11/21 End - 4/24/21 L33930 A57787 A58668
National Government Services Inc. Start - 3/11/21 End - 4/24/21 L35936 A57826 A58658
 Noridian Healthcare Solutions, LLC  Start - 3/11/21 End - 4/24/21  L38801  A58403  A58639
Noridian Healthcare Solutions, LLC Start - 3/11/21 End - 4/24/21  L38803  A58405  A58640
 Novitas Solutions Inc.  Start - 3/11/21 End - 4/24/21  L34892  A56670  A58667
 Palmetto GBA  Start - 3/11/21 End - 4/24/21  L38765  A58350  A58607
 Wisconsin Physicians Service Insurance Corporation  Start - 3/11/21 End - 4/24/21  L38841 DA58477  A58672

For questions on LCDs or CAC activities, please contact Alicia Blakey.