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Medical Policy Revision: Facet Joint Injections/Medial Branch Blocks

Effective June 11, 2018, we will change the way we process certain professional claims based on the guidelines of our medical policy, Facet Joint Injections/Medial Branch Blocks.

The guidelines of this new policy will, beginning June 11, 2018, replace the guidelines included in the following to-be-retired medical policies:

  • Cervical or Thoracic Facet Injections/Medial Branch Blocks (TX117)
  • Lumbar Facet Joint Injections/Medial Branch Blocks (TX109)

We encourage you review this content in our Medical Policy Manual.


Based on the guidelines of our medical policy, Facet Joint Injections/Medial Branch Blocks, and the submitted diagnosis code(s), claims for professional services provided on and after June 11, 2018 will be processed as noted below.

  • Claims that include CPT® codes 0213T, +0214T, +0215T, 0216T, +0217T, 64490, +64491, +64492, 64493 and/or +64494 may pend while information required to determine medical appropriateness is requested and reviewed.
  • CPT codes 0213T, +0214T, +0215T, 0216T, +0217T, 64490, +64491, +64492, 64493 and/or +64494 included on claims may be denied as services not related to the submitted diagnosis code(s).

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims on and after June 11, 2018.

CPT® is a registered mark of the American Medical Association.

Published on: March 12, 2018, 14:39 p.m. ET
Last updated on: March 12, 2018, 14:39 p.m. ET