Medical policy and guidelines

DISCLAIMER: Below are payers' guidelines and policy that we have been using  primarily for compliance, medical necessity and utilization guidelines. These policy serves as our guide in all that we do in revenue cycle management, patients access and prior authorization process and we are sharing this to our provider, group and facility clients. All these payer guidelines and the contents on this page are from its own sources and public web portals domain. It is always your responsibility to contact your local carriers, commercial payers, claims adjusters and case managers should you have any questions and any concerns regarding medical necessity policy and determination including utilization and medical/surgical frequency guideline. Reimbursement and clinical guideline questions should always be given to your payers and obtain information/answers from your insurance payers.

PAYERS LIST IS IN ANY ORDER

Medicare Part B New Jersey

Medicare Part B California

Medicare Part B Connecticut

​Medicare Part B Billing and Coding BOTOX Botulinum Toxins-Connecticut-A52848

Medicare Part B Hawaii

Medicare Part B New York

Medicare Part B Billing and Coding BOTOX Botulinum Toxins-New York-A52848

Medicare Part B Illinois

Medicare Part B Billing and Coding BOTOX Botulinum Toxins-Illinois-A52848

Medicare Part B Indiana

Medicare Part B Kansas

Medicare Part B Maine

Medicare Part B Missouri

Medicare Part B Billing and Coding BOTOX Botulinum Toxins-Massachusettes-A52848

Medicare Part B Nevada

Medicare Part B North Carolina

Medicare Part B Rhode Island

Medicare Part B Billing and Coding BOTOX Botulinum Toxins-Rhode Island-A52848

Medicare Part B South Carolina

Kyphoplasty Medicare South Carolina SC Local Coverage Determination for Vertebroplasty_Kyphoplasty (L33473)

Trigger Points Medicare South Carolina SC Local Coverage Determination for Trigger Point Injections (L37635)

Trial Stimulator South Carolina Medicare Local Coverage Determination for Spinal Cord Stimulators for Chronic Pain (L37632)

NCS EMG South Carolina SC Medicare Local Coverage Determination for Nerve Conduction Studies and Electromyography (L35048)

local_coverage_determination_for_facet_joint_injections_medial_branch_blocks_and_facet_joint_radiofrequency_neurotomy__l35996__mcr_mo.pdfFacet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy (L36471)

Medicare Part B Wisconsin

Medicare Part B Billing and Coding BOTOX Botulinum Toxins-Wisconsin-A52848​ 

For what you don't know may hurt you... always look for answers and always do the right thing.

Aetna Healthcare

Anthem Blue Cross Blue Shield of California 

Anthem Blue Cross Cryoneurolysis for Treatment of Peripheral Nerve Pain-SURG.00155
​Anthem Blue Cross Implanted Devices for Spinal Stenosis-DME.00025

Anthem Blue Cross Blue Shield of Colorado

​Anthem Blue Cross Blue Shield of Georgia

​Anthem Blue Cross Blue Shield of Indiana

​Anthem Blue Cross Blue Shield of Kentucky

Anthem Blue Cross Blue Shield of Maine

​Anthem Blue Cross Blue Shield of Missouri

Anthem Blue Cross Blue Shield of Nevada

​Anthem Blue Cross Blue Shield of New York

Anthem Blue Cross Blue Shield of Wisconsin

​Blue Cross Blue Shield of Kansas

Blue Cross Blue Shield of New Jersey

​Billing and Coding Temporomandibular Joint Disorder - Read Medical Policy of Horizon BCBSNJ

Billing and Coding Electromyography and Nerve Conduction Studies - Read Medical Policy of Horizon BCBSNJ

​Billing and Coding Ablation of Peripheral Nerves to Treat Pain - Read Medical Policy of Horizon BCBSNJ

​Blue Cross Blue Shield of Missouri

Blue Cross Blue Shield of North Carolina

Blue Cross Blue Shield of South Carolina

Centene Policy

Centene Policy - CP.MP.170. Nerve Blocks for Pain Management - Utilized by Home State Health and Ambetter

Cigna Healthcare

2020 Cigna Medical Policy for Facet Joint Injections and Medial Branch Blocks