What Does One Word Do to a Repeat Facet Ablation?
Novitas and First Coast posted their facet joint policies for notice this morning, effective December 6. The whole revision is one conjunction: 'and' becomes 'or' in the repeat radiofrequency ablation criterion. The other five MACs already carry it, and Palmetto logged the edit last October. The two jurisdictions arriving last hold $117.1 million of Medicare's facet ablation money, 39.7% of the national total. Also in the window: CMS quietly suspended the four-day IRF clock it set three weeks ago, and a gene therapy that has to be billed as thirty claims.
The Medicare Coverage Database download refreshed at 02:00 GMT this morning, its first movement in a week. Two policies inside it carry a notice date of today.
They are the last two facet joint LCDs in the country to change, and what changed is one word.
"What is a conjunction worth to a pain practice?"
One Word, Thirteen Months Late
L34892 (Novitas) and L33930 (First Coast) went to notice today with a revision effective date of December 6. Both filed the same reason for change, the database's code 70: "Creation of Uniform LCDs With Other MAC Jurisdiction."
The substance is in the policy's own issue field. The revision "expands coverage by reducing the criteria for repeat facet joint radiofrequency ablation (RFA) from two requirements to one," replacing "and" with "or" in the coverage indications.
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