Updated Medicare local coverage determination for facet joint injections for Medicare Plus BlueSM and BCN AdvantageSM members, starting April 25, 2021
For dates of service on or after April 25, 2021, the updated Medicare local coverage determination for facet joint interventions for pain management (L38841) applies.
The changes to the LCD include, but aren't limited to, the following:
As a reminder
When making authorization determinations for Medicare Plus Blue and BCN Advantage members, TurningPoint applies Medicare national coverage determinations / Medicare local coverage determinations.
If there is no Medicare NCD / LCD, TurningPoint applies medical policy guidelines for musculoskeletal and pain management procedures that Blue Cross Blue Shield of Michigan, Blue Care Network and TurningPoint agreed on.
For more information about the TurningPoint musculoskeletal surgical quality and safety management program, see the following pages of the ereferrals.bcbsm.com website:
TurningPoint manages authorizations for orthopedic, pain management and spinal procedures for the following:
*To determine whether you need to submit prior authorization requests for Blue Cross commercial members, see "How do I know if I need to request prior authorization from TurningPoint for members who have coverage through Blue Cross commercial plans?" in the Musculoskeletal procedure authorizations: Frequently asked questions for providers (PDF) document.
Posted: April 2021
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network