LCD for genicular nerve RFA 64624

[drpainfree]

anyone has a copy/link to it? I can't find it on CMS website where it talks about coverage details for it.

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[drpainfree]

anyone? so you guys have all been doing genicular nerve block/RFA since 2020 when these codes came out WITHOUT LCD to back them up?

 

[lobelsteve]

I do the block/rf. I bill the code. We get paid.

 

[Agast]

anyone? so you guys have all been doing genicular nerve block/RFA since 2020 when these codes came out WITHOUT LCD to back them up?

A peer to peer from AARP informed me that Medicare doesn’t actually address the genicular nerve procedures, which is why the Medicare replacement plans have an Out to deny them. Pretty much only primary Medicare will pay for the code now.

 

[thecentral09]

A peer to peer from AARP informed me that Medicare doesn’t actually address the genicular nerve procedures, which is why the Medicare replacement plans have an Out to deny them. Pretty much only primary Medicare will pay for the code now.

So educate me then if patient has it done. If Medicare is primary is a certain percentage (85%) of it paid, but the secondary does not cover the additional 15%?

 

[Agast]

So educate me then if patient has it done. If Medicare is primary is a certain percentage (85%) of it paid, but the secondary does not cover the additional 15%?

The secondary will pay because they are forced to cover something when Medicare is actively paying. Just like when you do an injection without documenting 6 weeks of failed PT.

 

[drpainfree]

A peer to peer from AARP informed me that Medicare doesn’t actually address the genicular nerve procedures, which is why the Medicare replacement plans have an Out to deny them. Pretty much only primary Medicare will pay for the code now.

right...but what we do if traditional Medicare denies a claim? I'm trying to read up on it in case it happens. I do have a specific question, though. Do you have to document 80% pain relief on 2 genicular blocks before doing RFA?