maximum time allowed between 2nd MBB and 1st RFA?

[ctts]

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After two successful Dx blocks, is there a maximum time allowed within which RFA has to be done? I have a patient in this situation, and we are holding off on RFA for a number of reasons, but wanting to know how long we can delay the RFA, without having to potential start over with MBB again, or do the RFA only to have it denied for payment. He has BCBS Commercial insurance. I do not see anything about this in BCBS medical policy or Medicare LCD.

 

[gaspasser127]

Safe bet is 1 year, but if you’re going to wait > 3 months and especially > 6 months prior to submitting for auth for RFA i would bring the patient back for a clinic visit to document that their pain is unchanged (still axial, no radic, not SIJ, positive facet loading) to minimize the risk of denial

 

[Ducttape]

nothing is specifically stated in the LCD, but in my limited experiences, the MBBs were "valid" for a year - with an insurer much stricter than BCBS.

 

[Ronin1]

BC only required one MBB

 

[cowboydoc]

BC only required one MBB

Every BC I’ve seen is 2 (Midwest)