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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101.

The rules say for Facet Joint Radiofrequency Neurotomy Ablation (RFA) the following are Limitations of Coverage: Facet joint nerve injections for the treatment of acute, non-recurrent neck or back pain, New onset radiculopathy precludes coverage of facet blockade except radicular pain caused by a facet joint synovial cyst in the lumbar spine. Intraarticular facet block will not be reimbursed as a diagnostic test unless medial branch blocks cannot be performed due to anatomic restrictions. A maximum of five (5) facet joint injection sessions inclusive of medial branch blocks, intraarticular injections, or facet cyst rupture and RF ablations may be performed per year in the cervical/thoracic spine and five (5) in the lumbar spine. For each covered spinal region (cervical/thoracic or lumbar), no more than two (2) joints bilaterally thermal RF sessions will be reimbursed in any calendar year, involving no more than four (4) joints per session. Repeat neurotomy procedures involving the same joint will only be considered medically necessary when the patient had equals 50% improvement of pain and documented improvement in patient specific ADLs documented for at least 6 months. Repeat therapeutic facet joint or medial branch injections involving the same joint will only be considered medically necessary when the patient had equals 50% improvement of pain and improvement in patient specific ADLs for at least 3 months. Neither conscious sedation nor Monitored Anesthesia Care (MAC) is routinely necessary for intraarticular facet joint injections or medial branch blocks and are therefore not reimbursable. Individual consideration may be given for payment in rare unique circumstances if the medical necessity of sedation is unequivocal and clearly documented. Non-thermal RF modalities for facet joint denervation including chemical, low grade thermal energy Intraarticular or extraarticular facet joint prolotherapy is not covered. For Frequency with criteria two diagnostic injections are allowed per region irrespective of the joints injected with maximum of 2 joints allowable per session per region. No more than 4 therapeutic facet joint nerve blocks per year are reimbursable with 2 levels per region, per session after the appropriate documentation of 80% improvement with diagnostic blocks for the duration of the local anesthetic, and with a total relief and improvement of at least 50% of 6 weeks (including greater than 80% relief and greater than 50% relief). Two radiofrequency neurotomies per year involving 2 joints per region per session may be performed 2 times a year with appropriate documentation of relief with dual MBBs and 5 to 6 months of pain relief and functional improvement after a session. You can find this information in Medicare's Local Coverage Determination (LCD): Facet Joint Injections, Medial Branch Blocks, and Facet Joint Radiofrequency Neurotomy (L34832).

If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.