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Facet Joint Injections/ Medial Branch Blocks - (Effective Date - 2026-10-15) 7.01.116
Effective date
Oct 15, 2026
Identified
Jul 16, 2026
Summary
Excellus's facet joint injection and medial branch block policy, effective October 15, 2026, sets criteria for diagnostic and therapeutic facet injections and applies them only to facet-mediated pain. The 06/18/26 annual review left the policy intent unchanged. Injections performed under ultrasound guidance, or with injectates other than anesthetic, corticosteroid or contrast agents, are considered investigational, and injections on more than three contiguous levels are considered not medically necessary.
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What to do
Action · 4 steps
01Already effective 2026-10-15: Claims for a diagnostic facet joint injection need documentation of pain persisting for at least 3 months despite at least 4 weeks of appropriate conservative treatment in the past 3 months, or the reason conservative treatment is contraindicated; predominantly axial pain from C2-C3 to L5-S1; no more than three facet levels per session; and a facet radiofrequency denervation or ablation being considered.
02A second diagnostic injection needs a positive response of at least 80% relief from the first at the same level.
03Therapeutic injections given as an alternative to radiofrequency ablation need a contraindication (established spinal pseudoarthrosis or an implanted electrical device) and two documented positive diagnostic injections at the same level.
04Injections performed without fluoroscopic or CT guidance, on the same day as another invasive procedure, above C2-C3 or below L5-S1, or after a prior successful radiofrequency ablation at the requested level are considered not medically necessary.
Codes mentioned
644906449164492644936449464495
Original notice
Facet Joint Injections/ Medial Branch Blocks - (Effective Date - 2026-10-15) 7.01.116
excellusbcbs.com · Always check the source before changing claims.
Related changes
See all Excellus BlueCross BlueShield changes →Interventional Pain Management for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.122MediumEffective Jan 1, 2027 · Bone & Joints (Orthopedic)Facet Joint Injections/ Medial Branch Blocks 7.01.116HighEffective Oct 15, 2025 · Bone & Joints (Orthopedic)Facet Joint Injections/ Medial Branch Blocks 7.01.116HighEffective Oct 15, 2025 · Bone & Joints (Orthopedic)Browse every Excellus BlueCross BlueShield change in the policy list