AAPM&R Works with United Healthcare to Successfully Revise Facet Joint Injection Policy

Members of the Academy’s Medical Practice Committee advocated for additions to the list of diagnosis codes for UnitedHealthcare’s (UHC) Facet Joint Injections Reimbursement Policy. The outcome of the Academy’s efforts is reimbursement for facet joint injections, 64470, 64472, 64475, and 64476, when reported in conjunction with one of four new ICD-9-CM codes now listed in the policy. The new ICD-9-CM codes are: 724.8 – facet syndrome, 723.8 – other syndromes affecting cervical region, 733.95 – spine fracture, and 737.30 – scoliosis.

Prior to changing the policy, UHC did not reimburse for facet injections when used in conjunction with these ICD-9-CM codes. The Academy felt it was important to have the new diagnosis codes included in the UHC policy, as they are conditions that can result in improved patient outcomes when treated with facet injections. The Academy provided UHC with clinical expertise in this area during a recent conference call with two of their Medical Directors.

The changes will be implemented in August 2008.