Wiki New LCD for RFA's

[mhstrauss]

Several of my Pain Management docs just went to a conference in Vegas, and were told that Medicare would have new coverage guidelines for cervical and lumbar RFA's in 2015....would now require patients to have 2 MBB's with at least 80% improvement in order to have RFA done. I have looked all over CMS and my MAC (Novitas) LCD's and NCD's, and have Googled this every way I can think of, and I cannot find anything that supports this information. Has anyone else heard this? One of the docs just told me (of course after I spent a good bit of time researching) that he thinks that whoever said that was referring to possible future changes, but I just thought I'd see if anyone else has come across this info.

TIA!!

 

[dwaldman]

Maybe you could determine from the brochure or presentation notes from the conference who was the presenter and try to email them for more information.

You could also look the Medicare carrier's website that you bill under "Draft" or "Future" policies to see if they planned to revised in addition to their ICD-10 embedded policies they will be rolling out.

 

[mhstrauss]

Maybe you could determine from the brochure or presentation notes from the conference who was the presenter and try to email them for more information.

You could also look the Medicare carrier's website that you bill under "Draft" or "Future" policies to see if they planned to revised in addition to their ICD-10 embedded policies they will be rolling out.

Thanks for the response! I have looked through draft and future policies and didn't see anything, and my doc didn't have any notes or anything, but I will look into the "ICD-10" angle!

 

[marvelh]

The Noridian coverage policy that includes most of the western and northwestern US states, including Nevada, includes the following excerpt:

Diagnostic Facet Joint Injections

Dual MBBs (a series of two MBBs) are necessary to diagnose facet pain due to the unacceptably high false positive rate of single MBB injections.

A second confirmatory MBB is allowed if documentation indicates the first MBB produced≥ 80% relief of primary (index) pain and duration of relief is consistent with the agent employed.​

Not all Medicare coverage policies are indentical.

 

[mhstrauss]

The Noridian coverage policy that includes most of the western and northwestern US states, including Nevada, includes the following excerpt:

Diagnostic Facet Joint Injections

Dual MBBs (a series of two MBBs) are necessary to diagnose facet pain due to the unacceptably high false positive rate of single MBB injections.

A second confirmatory MBB is allowed if documentation indicates the first MBB produced≥ 80% relief of primary (index) pain and duration of relief is consistent with the agent employed.​

Not all Medicare coverage policies are indentical.

This is exactly the type of wording I wish Novitas would add to their policy!
Thanks for your response.