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Wiki RFA denial

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rolltide

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LCD policy for CPT 64635 states: A maximum of two (2) facet destruction sessions per nerve level per year may be performed in the lumbar region. Does this mean only 2 (no matter what side), or 2 on the left (L3-L5) and 2 on the right (L3-L5) same levels only different sides. Our office has started getting denials on these. Also does the year go by Jan-Jan or rolling calender year? Any help would be appreciated.
 
I agree the language with those is difficult to determine what they are referring to (ie, side or number of total procedures regardless of side). I think I would move forward with a formal appeal and potentially second level appeal to receive in writing what their stance is.
 
I think it is pretty clear it is per nerve level in the lumbar region. not per side per level so 2 total for the year per level so if you perform 2 on the right (L3-L4) then you are done at the L3-L4 level for the year or it will be patient responsibility.
also year has always been defined as 365+1 day from the time of the last treatment.
 
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