Search results with tag "Facet medial branch nerve block"

HUMANA Pain Management Prior Authorization Request …

Facet Medial Branch Nerve Block: Local Steroid RFA 1. Primary Diagnosis Code Cervical Thoracic Lumbar Sacral Please Select Spinal Region(s) which applies: If yes, ____% Pain Relief lasted ____ weeks from last (Epidural or Facet injection) performed on Date:_____ 4. Previous Epidural or Facet Injections(s)? Yes No

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