Effective July 2024: Important Medicare Policy Changes on Anesthesia and Sedation Coverage for Facet Joint Injections

As healthcare practices strive to provide the best care for their patients, staying updated with the latest policy changes is crucial. Effective from July 2024, Medicare has introduced significant changes in the coverage of anesthesia and sedation for facet joint injections. These changes impact practices across multiple states and require careful attention to documentation and procedural justification.

Key Changes in Medicare Policy

The new policy outlines that the use of Moderate or Deep Sedation, General Anesthesia, and Monitored Anesthesia Care (MAC) is generally not considered medically reasonable and necessary during facet joint procedures. Specifically, for intra-articular (IA) medial branch blocks (MBB) and facet cyst aspiration/rupture, routine use of these anesthesia methods is discouraged.

However, exceptions are made in individual cases where documentation shows a longstanding history of medical necessity, such as:

• Inability to cooperate due to medical conditions.
• Conditions prohibiting procedure performance.
• Inability to remain motionless during the procedure.

Patient anxiety or preference alone is not sufficient justification for the use of Moderate Sedation, MAC, General Anesthesia, or Deep Sedation. Routine application of these anesthesia methods for radiofrequency ablation (RFA) is also not considered reasonable and necessary unless justified by medical documentation.

Specific Policy Updates by Contractor

• NGS (L35936): Effective 7/31/2024. Applicable in CT, IL, MA, ME, MN, NH, NY, RI, VT, WI.
• CGS (L38773): Effective 7/7/2024. Applicable in KY, OH.
• Novitas (L34892): Effective 8/11/2024. Applicable in AR, CO, DC, DE, LA, MD, MS, NM, NJ, OK, PA, TX.
• First Coast (L33930): Effective 8/11/2024. Applicable in FL, PR, VI.
• Noridian (L38803): Effective 7/7/2024. Applicable in AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY, AS, CA, GU, HI, MP, NV.
• WPS (L38841): Effective 7/15/2024. Applicable in IA, KS, MI, MO, NE.
• Palmetto (L38765): Effective 7/7/2024. Applicable in AL, GA, NC, SC, TN, VA, WV.

These updates are crucial for ensuring compliance and optimizing patient care. Healthcare practices must review these changes and adjust their procedures and documentation accordingly.

For more detailed information on how these policy changes may impact your practice and to ensure you are in full compliance, Contact us for Pain Management Medical Billing Service at Svast Healthcare Technologies.

Staying updated with Medicare policy changes is essential for maintaining the highest standards of patient care and ensuring compliance. By understanding and implementing these new guidelines, healthcare practices can continue to provide effective and efficient care for their patients.

For further assistance and to stay informed on all updates, follow our blog at Svast Healthcare Technologies.