Transcription of Local Coverage Determination for Destruction of ...
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Local Coverage Determination (LCD) for Destruction ofParavertebral facet Joint Nerve(s) (L29132)Contractor InformationContractor NameFirst Coast Service Options, Number09102 Contractor TypeMAC - Part BBack to TopLCD InformationDocument InformationLCD ID NumberL29132 LCD TitleDestruction of Paravertebral facet JointNerve(s)Contractor's Determination Number64633 AMA CPT/ADA CDT Copyright StatementCPT codes, descriptions and other data onlyare copyright 2011 American MedicalAssociation (or such other date of publicationof CPT). All Rights Reserved. ApplicableFARS/DFARS Clauses Apply. Current DentalTerminology, (CDT) (including procedurecodes, nomenclature, descriptors and otherdata contained therein) is copyright by theAmerican Dental Association. 2002, 2004 American Dental Association. All rightsreserved. Applicable FARS/DFARS Geographic JurisdictionFloridaOversight RegionRegion IVOriginal Determination Effective DateFor services performed on or after 02/02/2009 Original Determination Ending DateRevision Effective DateFor services performed on or after 01/01/2012 Revision Ending DateCMS National Coverage PolicyLanguage quoted from CMS National Coverage Determination (NCDs) and coverageprovisions in interpretive manuals are italiciz
64633 destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or ct); cervical or thoracic, single facet joint
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Local Coverage Determination for Paravertebral Facet, Injection, Facet, Disc Degeneration, Nerve Impingement, and, Cervical, Cervical Facet joint Medial branch block, FUSION PROCEDURES, Medtronic, GUIDELINES FOR TREATMENT OF THE CERVICAL SPINE, CHRONIC INTRACTABLE PAIN MANAGEMENT, HUMANA Pain Management Prior Authorization, PHC TAR REQUIREMENTS