This means a maximum of one injection on the right and one on the left in two separate joints for a total of four injections in one region (cervical/thoracic or lumbar-sacral) per session (same day). For unilateral injections, this means a maximum of two injection on the right or two on the left in two separate joints within one region for a total of two injections.
Despite the support from the pain management community demonstrated above to allow three or more levels routinely, this practice is not supported in the medical literature. No supporting literature was provided with the above comments that support the concept that the facet pain may extend routinely beyond 1-2 levels. During the CAC meeting, prevalence data was shared, demonstrating L4/L5 followed by L5/S1 levels comprise around 80% of the overall prevalence for lumbar spinal pain. In the cervical spine, C2/3 represents 50%, followed by C5/C6 and C6/7. This was correlated with Medicare national data, which demonstrates that most facet procedures involve 1-2 levels, with more than two levels being in the minority of procedures performed. If additional literature is published in peer-reviewed journals that provide evidence of the medical necessity for treating three or more levels in the same session, this can be considered on reconsideration.
