Notification

Musculoskeletal Services (Independence)


Notification Issue Date: 10/16/2018



Policy Attachment


Attachment to Policy # 00.01.66b


Attachment:C

Policy #:00.01.66b

Description:Procedures Codes for Interventional Pain Management

Title:Musculoskeletal Services (Independence)


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.


Musculoskeletal Services: Interventional Pain Management Procedure Codes that require precertification/preapproval through AIM Specialty Health® (AIM)

Sacroiliac Injection  (SI JOINT Injection)
27096
G0260
Cervical or thoracic epidural steroid injection
62320
62321
64479
64480
Lumbar or sacral epidural steroid injection
62322
62323
64483
64484
Cervical or thoracic facet injection
64490
64491
64492
Lumbar or sacral facet injection
64493
64494
64495
Cervical radiofrequency ablation
64633
64634
Lumbar radiofrequency ablation
64635
64636
Implantation of Spinal Cord Stimulators
63650
63655
63663
63664
63685
63688
Regional Sympathetic Nerve Blocks
64510
64520



Version Effective Date: 01/14/2019
Version Issued Date: 01/14/2019
Version Reissued Date: N/A

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