Facet Joint Denervation Requires Prior Review as of April 1
Effective April 1, 2012, facet joint denervation for chronic neck and back pain will require prior review/certification by Blue Cross and Blue Shield of North Carolina (BCBSNC). An updated medical policy is available online for your review at http://www.bcbsnc.com/providers.
Also, as of January 1, 2012, there are new CPT codes (64633, 64634, 64635, and 64636) for use when filing for facet joint denervation services. The previous CPT codes (64623, 64626 and 64627) were deleted at the end of 2011.
Call us at 1-800-672-7897 to initiate the prior review process for these services or any other services requiring prior review. Specific coverage criteria are outlined in the related medical policy.
This prior review requirement will apply to BCBSNC commercial members, including State Health Plan members, but will not apply to Federal Employee Program or Blue MedicareSM members.
For more information, please refer to these FAQs or contact your local BCBSNC Network Management representative.