Traditional MedicareCoverageHigh impact
Facet Joint Interventions for Pain Management
Medicare/CMS - LCD·Pain Management, PM&R (Physical Medicine & Rehab), Orthopedics +2 more·Local Coverage Determination
Effective date
Apr 9, 2026
We identified it
Jun 17, 2026
Summary
This is a new Local Coverage Determination (LCD) for facet joint interventions used in pain management, administered by National Government Services as the Medicare Administrative Contractor. The policy will establish coverage criteria and billing requirements for facet joint procedures under Medicare Parts A and B.
Action Required
By April 9, 2026: Billing team must review the full LCD L35936 policy text to understand new coverage criteria for facet joint interventions. Update billing software and encounter forms with any new prior authorization requirements, documentation standards, or coverage limitations specified in the policy. Ensure providers are trained on any new medical necessity criteria to prevent claim denials.