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August 15, 2024

Changes to Prior Authorization for Facet Joint Interventions

According to the revised Local Coverage Determination (LCD), Facet Joint Interventions for Pain Management (L38773)External Website, three or four-level procedures are not medically necessary and, therefore, are non-covered. (See #7 under Limitations.)

As a result, CMS:

  • Determined that a prior authorization request for these procedures is unnecessary since the decision will always be non-affirmative.
  • Removed CPT codes 64492 and 64495 from the list of codes that require prior authorization as a condition of payment.

Updates to the following resources reflect this change:

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