Current Procedural Terminology (CPT) and National Uniform Billing Committee (NUBC) Licenses
My favorite part- nurse weekend courses equal to residency
Acceptable training or certification may be evidenced by any one of the following means:
Regarding sedation- CS with RFA will lead to CMS audits....
My favorite part- nurse weekend courses equal to residency
Acceptable training or certification may be evidenced by any one of the following means:
- Satisfactory completion of an Accreditation Council for Graduate Medical Education (ACGME) or American Osteopathic Association (AOA) accredited residency and/or fellowship program in a relevant specialty (e.g., Interventional Pain Management, Anesthesiology); or
- Board certification in a relevant specialty by an American Board of Medical Specialties (ABMS) member board or equivalent AOA board; or
- Satisfactory completion of an accredited non-physician practitioner educational program that provides substantially equal content and scope as those mentioned in bullets 1 or 2 above and includes the minimum requirements stated in the preceding paragraph (see * above), with trainee competency directly assessed by state licensure examination or certification examination by a nationally recognized accrediting agency and maintenance of a case log of procedures performed; or
- Demonstration of satisfactory performance of the specific interventional pain management services in this policy on a regular basis over the five years immediately preceding implementation of this policy. Medicare considers an average of ten services per month to meet this requirement, and may be substantiated by Medicare or other payer claim history supported by patient medical records of appropriate care, procedural performance and outcomes.
Regarding sedation- CS with RFA will lead to CMS audits....
- General anesthesia is considered not reasonable and necessary for facet joint interventions. Neither conscious sedation nor Monitored Anesthesia Care (MAC) is routinely necessary for facet joint interventions and are not routinely reimbursable. Individual consideration may be given on redetermination (appeal) for payment in rare unique circumstances if the medical necessity of sedation is unequivocal and clearly documented in the medical record. Please refer to LCD L35049 Monitored Anesthesia Care for additional information. Frequent reporting of these services together may trigger focused medical reviews.
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