Traditional MedicareCoverageHigh impact
Facet Joint Interventions for Pain Management
Medicare/CMS - LCD·Pain Management, Orthopedics, PM&R (Physical Medicine & Rehab) +2 more·Local Coverage Determination
Effective date
Apr 9, 2026
We identified it
Jun 17, 2026
Summary
A new Local Coverage Determination for Facet Joint Interventions for Pain Management has been established by Palmetto GBA, effective April 9, 2026. This policy will govern Medicare coverage criteria for facet joint procedures including injections and radiofrequency ablation.
Action Required
By April 9, 2026: Billing team must review the full LCD L38765 policy document at cms.gov to identify specific coverage criteria, documentation requirements, and affected CPT codes for facet joint interventions. Update billing system rules and provider templates to ensure compliance with new Medicare coverage requirements. Claims may be denied if new criteria are not met.