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Date Printed: June 25, 2017: 01:17 PM

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Subject: Facet Joint Injections

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This medical coverage guideline is not an authorization, certification, explanation of benefits, or a guarantee of payment, nor does it substitute for or constitute medical advice. All medical decisions are solely the responsibility of the patient and physician. Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. This medical coverage guideline applies to all lines of business unless otherwise noted in the program exceptions section.

 

DESCRIPTION

Facet joint injection is also called facet joint nerve block or medial branch block. This treatment may help manage pain caused by nerve irritation at the facet joints between the bones in the spine. Facet joint injections may be given in the neck or lower back.

In this treatment, your doctor inserts a long needle into the facet joint or facet joint nerve between the bones in your spine. An x-ray device called a fluoroscope or other imaging device such as a CT scanner is used to position the needle. Your doctor then injects medicine to block the pain and reduce swelling. The treatment is often administered in an outpatient setting.

After taking your medical history and examining you, your doctor will evaluate you for treatment. Your doctor may first try other more conservative treatments to relieve your pain. If these do not offer relief, your doctor may then try facet joint injections.

Typically, you will first receive one to two injections to see if the treatment will relieve your pain. If your pain improves, you may receive additional injections over time. Your doctor will continue to measure your improvement.

Visit the Clinical View of this guideline for more information.

Visit WebMD for more information on using facet joint injections to treat pain.

COVERAGE

 

Note: For all medical decisions about this service, Florida Blue uses the Position Statement in the Clinical View of this medical coverage guideline. To make the best decision for your health needs, talk to your doctor. The services covered vary from health plan to health plan. Refer to your health plan contract for complete information about your coverage.

 

Facet joint injections may be covered if certain requirements are met for:

• acute and chronic neck pain

• acute and chronic low back pain

Visit the Clinical View of this guideline for specific coverage information.

PROGRAM EXCEPTIONS

• Federal Employee Program (FEP): Certain exceptions apply.

• State Account Organization (SAO): Certain exceptions apply.

• Medicare Advantage products: Certain exceptions apply.

Visit the Clinical View of this guideline for more coverage information.

Refer to your health plan contract for complete information about your coverage.

Date Printed: June 25, 2017: 01:17 PM