New National Facet Policies Update

As many of you are aware, there has been a push by the CMS contractors to have the same policies across all jurisdictions.  Well, the new facet policy is here and is being rolled out by many of the intermediaries in the month of April. 

Most of the documentation requirements and medical utilization remain the same.  The one new billing change is the use of the KX modifier for diagnostic injections.  This is to help carriers track utilization.  Below is the expert from the First Coast policy, but the same verbiage has been seen in WPS and Novitias.

“KX modifier requirements: The KX modifier should be appended to the line for all diagnostic injections. In most cases, the KX modifier will only be used for the two initial diagnostic injections. If the initial diagnostic injections do not produce a positive response as defined by the LCD and indicative of identification of the pain generator, and it is necessary to perform additional diagnostic injections, append the KX modifier to the line. Aberrant use of the KX modifier may trigger a focused medical review.”

First Coast Policy, National Government Services (NGS), Noridian, Novitias, Palmetto, and Wisconsin Physician Services (WPS) all list that the facet policy is to go into effect on April 25th, 2021.  CGS is scheduled for May 2nd, 2021.

Please alert your physicians that designating diagnostic or therapeutic is now extremely important and you will need to begin using the KX modifier on dates after the effective date of the policy.

This is only for facet injections currently.  They are working on the national roll-out of epidurals next.

Stay tuned!

As always, we hope you find this alert helpful. 

Devona