medicare - repeat ESI after 14 days, facet block minimum of 2 weeks

[ctts]

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Medicare LCD states "...repeat ESI after 14 days..."
Do you know if that means on the 14th day, or do we have to wait until the 15th day?
For example, if ESI is done today on Wed 10/15/25, can I repeat on Wed 10/29/15 or do I have to wait until Thurs 10/30/25?

Similarly, for facets, Medicare LCD states: "The second diagnostic procedure may only be performed a minimum of 2 weeks after the initial diagnostic procedure." The wording here is slightly different.
If facet block is done today on Wed 10/15/25, can I repeat facet block on Wed 10/29/15 or do I have to wait until Thurs 10/30/25?

And to clarify, there is no minimum wait time specified between the second dx facet block and RFA, so that means RFA could be done as early as the day after the second block?

Asking these questions because I just received a rejection from Medicare for exceeding 4 ESIs in last 12 months. Something like 7/14/24, 10/14/24, 1/14/25, 3/14/25, 7/14/25
The one on 7/14/25 got rejected, but if I had waited ONE more day until 7/15/25, it would have been paid.

 

[Taus]

Mbb are min 2 weeks apart
Esi are min 3 months apart (for same esi)

 

[MitchLevi]

MBB 2W apart is BS, and I do not wait.

 

[Taus]

MBB 2W apart is BS, and I do not wait.

I will post the amazing denial letter I got yesterday from Medicare for repeat mbb. I do 90% of my procedures in the office. I go to an OR in practices specialty hospital once per month, where these require prior auth with Medicare due to hospital setting. Elderly patient who lives much closer hospital be preferred to wait for it for their MBB. (Booked out 2 months). Repeat denied as the request did not specifically state that the date of the repeat was going to be two weeks from the prior mbb. We submitted the request for prior auth the day after initial positive mbb when received the pain diary. Un f’ing believable.

 

[Taus]

MBB 2W apart is BS, and I do not wait.

I would presume this opens you up to audit for that second MBB and the subsequent Rfa.

 

[Dr. Ice]

Everyone waits for everything and can’t repeat same exact epidural at same level unless minimum of 3 months since last shot. Maybe I can do a follow up injection through a different approach or at a different level if partial response from first shot…maybe

 

[Ducttape]

I started asking for auth 90 days from date of last injection after getting denied for one when submitted day 88 for all Option plans; specifically in denial said that there was no proof the first esi provided benefit for 90 days.

 

[pmrmd]

MBB 2W apart is BS, and I do not wait.

Dude. Yes, it is BS. Yes, you do wait. You’re powerless in this situation.

 

[ctts]

Mbb are min 2 weeks apart
Esi are min 3 months apart (for same esi)

I should have clarified, for repeat ESI, I am talking about failure to respond to the initial ESI.
Medicare LCD states, "If a patient fails to respond well to the initial ESI, a repeat ESI after 14 days can be performed using a different approach, level and/or medication..."

 

[Taus]

I should have clarified, for repeat ESI, I am talking about failure to respond to the initial ESI.
Medicare LCD states, "If a patient fails to respond well to the initial ESI, a repeat ESI after 14 days can be performed using a different approach, level and/or medication..."

Right…. Key is DIFFERENT ESI.

 

[ctts]

Right…. Key is DIFFERENT ESI.

Right.
Per Medicare, "using a different approach, level and/or medication"
So if anatomical limitations, post-surgical limitations, same approach can be used if necessary, if different steroid used.

A lot of responses so far, but no specific answer as to whether injection can be done on day 14, or if it has to wait for day 15. Due to the precedent set by the frequency rejection scenario that I mentioned in the original post (exceeding 4 ESIs in 12 month period), my biller is now saying that a repeat injection on day 14 would result in rejection, so I need to wait until day 15. I am not sure that we know this for sure though.
(The reason it matters for me is because I am in one office 2 days and another office 2 days, so not being able to repeat on day 14, may mean my patient will not be able to have the procedure done until an additional week later when I am back in the same office, rather than just 1 day later.)

 

[mdo1738]

I would recommend always following their rules to the exact letter if you don’t want to be at risk of payment being recouped on audit. My interpretation is that after 14 days specifically by the letter of the law is after 14 days, not on the 14th day. Don’t ever try to be logical or outsmart the LCD. Always assume the worst possible interpretation for you and/or the patient is indeed the correct interpretation.

 

[JFS]

I’m HOPD. I got a denial for RFA because of 2nd MBB done accidentally 10 days later from first MBB (scheduling error on my staff). Had to repeat MBB (so 3 MBBs), then got denied RFA for too many MBBs. Had to resubmit and “forget” to mention the first MBB in our notes and submission.

No issues if done 14 days on the dot aka Wednesday to Wednesday

 

[IAmTheOne1]

Right.
Per Medicare, "using a different approach, level and/or medication"
So if anatomical limitations, post-surgical limitations, same approach can be used if necessary, if different steroid used.

A lot of responses so far, but no specific answer as to whether injection can be done on day 14, or if it has to wait for day 15. Due to the precedent set by the frequency rejection scenario that I mentioned in the original post (exceeding 4 ESIs in 12 month period), my biller is now saying that a repeat injection on day 14 would result in rejection, so I need to wait until day 15. I am not sure that we know this for sure though.
(The reason it matters for me is because I am in one office 2 days and another office 2 days, so not being able to repeat on day 14, may mean my patient will not be able to have the procedure done until an additional week later when I am back in the same office, rather than just 1 day later.)

You're right, nobody actually answered your question lol but I will.

So I was in the exact situation as you wondering about this after getting a denial because we did a repeat epidural two weeks later (Did first one on a Thursday, and 2nd one exactly two weeks later also on a Thursday). It was DENIED. Why? They count day 1 as the day after the injection. We appealed, it was still denied. So if you do it on a Thursday for example, don't do the repeat until the Friday two weeks later. Any sooner and it can get denied with no hope of winning an appeal.