CommercialCoverageHigh impact
Facet Joint Injections/ Medial Branch Blocks 7.01.116
Excellus BlueCross BlueShield·Orthopedics, Pain Management, PM&R (Physical Medicine & Rehab) +1 more·Bone & Joints (Orthopedic)
Effective date
Oct 15, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their facet joint injection and medial branch block policy with specific criteria for diagnostic, therapeutic, and synovial cyst aspiration procedures. The policy establishes strict requirements including 3+ months of pain, 4+ weeks of conservative treatment, and limits injections to 3 spinal levels per session.
Action Required
By October 15, 2025: Update prior authorization protocols for facet joint injections to ensure all diagnostic injections meet new criteria (3+ months pain duration, 4+ weeks conservative treatment, maximum 3 spinal levels). Train providers on documentation requirements for 80% pain relief response and contraindications. Update billing system to flag therapeutic injections requiring 6-month intervals and 50% pain relief for 12+ weeks.