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Facet Joint Injections/ Medial Branch Blocks 7.01.116
Act
by Oct 15, 2025
Effective date
Oct 15, 2025
Identified
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their facet joint injection and medial branch block policy with specific criteria for diagnostic, therapeutic, and synovial cyst aspiration procedures. The policy establishes strict requirements including 3+ months of pain, 4+ weeks of conservative treatment, and limits injections to 3 spinal levels per session.
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What to do
by Oct 15, 2025 · 3 steps
01Update prior authorization protocols for facet joint injections to ensure all diagnostic injections meet new criteria (3+ months pain duration, 4+ weeks conservative treatment, maximum 3 spinal levels).
02Train providers on documentation requirements for 80% pain relief response and contraindications.
03Update billing system to flag therapeutic injections requiring 6-month intervals and 50% pain relief for 12+ weeks.
Original notice
Facet Joint Injections/ Medial Branch Blocks 7.01.116
excellusbcbs.com · Always check the source before changing claims.
Related changes
See all Excellus BlueCross BlueShield changes →Facet Joint Injections/ Medial Branch Blocks 7.01.116HighEffective Oct 15, 2025 · Bone & Joints (Orthopedic)Facet Joint Injections/ Medial Branch Blocks - (Effective Date - 2026-10-15) 7.01.116MediumEffective Oct 15, 2026 · Bone & Joints (Orthopedic)Browse every Excellus BlueCross BlueShield change in the policy list