Medicare Billing Updates for Facet Joint Injections in 2026
Key Highlights
- Medicare has strengthened coding guidance for facet joint injections, focusing on correct CPT codes, imaging use, and proof of medical necessity to minimize denials.
- Complete and precise documentation is now essential for payment approval, including treated spinal levels, imaging confirmation, prior conservative treatments, and detailed pain history.
- Medicare is strictly monitoring injection frequency limits, requiring separate and accurate coding for diagnostic injections, therapeutic injections, and radiofrequency ablation procedures.
- Working with specialized billing partners like Simplen Billing helps practices stay compliant, improve reimbursement rates, and reduce audit risks.
In this blog, we explain what facet joint injections are, what Medicare’s new coding guidance includes, and how healthcare providers can stay compliant.
What Are Facet Joint Injections?
Facet joints are small joints located between each vertebra of the spine. They stabilize the spine and support smooth movement. When inflamed or damaged, they can cause chronic neck and back pain.
During the procedure, physicians inject:
- A local anesthetic for immediate pain relief
- A corticosteroid to reduce inflammation
- Imaging guidance such as fluoroscopy or CT for accuracy
These injections are used both to identify the pain source and to provide longer-term relief.
Why Medicare Issued New Coding Guidance
Facet joint injections are high-volume procedures, which makes them a focus for Medicare audits and payment reviews. Many claims are denied due to:
- Incorrect CPT codes
- Poor documentation
- Overuse of procedures
- Missing proof of medical necessity
The updated guidance aims to standardize billing and reduce improper payments.
Medicare’s Key Rules for Coding Facet Joint Injections
1. Correct CPT Code Selection
Medicare requires precise coding based on:
- Spinal region (cervical, thoracic, lumbar, sacral)
- Number of levels treated
- Whether the injection is diagnostic or therapeutic
Using add-on codes incorrectly is one of the top billing errors.
2. Imaging Guidance Is Mandatory
Claims must show that fluoroscopy or CT imaging was used. Documentation should include:
- Type of imaging method
- Confirmation of needle placement
- Procedure notes
Without this, Medicare may deny the claim.
3. Proof of Medical Necessity
Medicare covers facet joint injections only when:
- Pain is chronic and functionally limiting
- Conservative treatments have failed
- Clinical findings support the procedure
Clear documentation is essential for approval.
4. Frequency Limits
Medicare restricts how many injections a patient can receive per year per spinal region. Providers must show significant pain relief before repeating treatments.
5. Separate Coding for RFA
Diagnostic injections, therapeutic injections, and radiofrequency ablation must each be coded individually. Combining them incorrectly may result in denied claims.
Common Mistakes Providers Should Avoid
- Billing too many spinal levels
- Skipping imaging documentation
- Repeating injections too frequently
- Incorrect modifier usage
- Weak medical necessity notes
How Simplen Billing Supports Compliance
Simplen Billing specializes in pain management and interventional procedure billing, helping providers:
- Ensure accurate CPT and ICD-10 coding
- Improve clean claim rates
- Reduce denials and audit risks
- Speed up reimbursements
With Medicare tightening compliance standards, expert billing support can protect both revenue and reputation.
Final Thoughts
Medicare’s updated guidance on facet joint injection coding focuses on accuracy, patient safety, and cost control. While the rules may feel complex, following them carefully ensures proper reimbursement and long-term compliance.
Clinics that prioritize strong documentation, correct coding, and expert billing processes will continue to succeed in today’s strict healthcare environment.
FAQs
1. What is Medicare’s guidance on facet joint injection coding?
Medicare has clarified how facet joint injections should be coded, focusing on correct CPT code selection, proper documentation, imaging guidance, and proof of medical necessity to reduce billing errors and claim denials.
2. Does Medicare require imaging guidance for facet joint injections?
Yes. Medicare requires fluoroscopy or CT imaging to confirm accurate needle placement. Claims without documented imaging guidance are likely to be denied.
3. How many facet joint injections does Medicare allow per year?
Medicare places limits on the number of diagnostic and therapeutic facet joint injections allowed per spinal region each year. Exceeding these limits without strong clinical justification can trigger denials or audits.
4. What documentation is required for Medicare reimbursement?
Providers must document chronic pain duration, failed conservative treatments, functional limitations, spinal levels treated, and the use of imaging guidance during the procedure.
5. Why are facet joint injection claims often denied by Medicare?
Common reasons include incorrect CPT codes, missing imaging documentation, weak medical necessity, exceeding frequency limits, and improper modifier usage.