Wiki RFA LCD Updated policy

[lcole7465]

I have a question on the updated LCD policy for the RFA's. If the provider does a bilateral on 1 level, will he be able to have the patient come back within the 12 month period to have another bilateral for the level performed?

 

[jkyles]

Hi there, the answer (Yes) is scattered through the LCD, the billing & coding article and the response to comments

Frequency Limitation: For each covered spinal region no more than two (2) radiofrequency sessions will be reimbursed per rolling 12 months.

One to two levels, either unilateral or bilateral, are allowed per session per spine region. The need for a three or four-level procedure bilaterally may be considered under unique circumstances and with sufficient documentation of medical necessity on appeal. A session is a time period, which includes all procedures (i.e., medial branch block (MBB), intraarticular injections (IA), facet cyst ruptures, and RFA ablations that are performed during the same day.

Unilateral or bilateral facet interventions may be performed during the facet joint procedure (a diagnostic nerve block, a therapeutic facet joint (intraarticular) injection, a medial branch block injection, or the medial branch radiofrequency ablation (neurotomy) in one session. A bilateral intervention is still considered a single level intervention.