Mississippi Administrative Code › Title 20 - Labor › Part 2 - Mississippi Workers' Compensation Medical Fee Schedule › PAIN MANAGEMENT › Section 20-2-II - REIMBURSEMENT FOR PAIN MANAGEMENT SERVICES

Current through June 25, 2024
A.
Use of
				Fluoroscopy.
, Fluoroscopic guidance, CPT codes 77002 and 77003, may be
				billed once per date of service. Use CPT code 77002, fluoroscopic guidance for
				needle placement with CPT code 64510, injection anesthetic agent; stellate
				ganglion (cervical sympathetic) , or CPT code 64520, injection anesthetic
				agent; lumbar or thoracic (paravertebral sympathetic).
Use CPT code 77003, for fluoroscopic guidance and
				  localization of needle or catheter tip for spine or paraspinous diagnostic or
				  therapeutic injection procedures (e.g., cervical epidural or sacroiliac joint),
				  and including facet nerve neurolytic agent destruction.
All procedures performed fluoroscopically MUST have stored
				  hard copy or digital images showing final needle placement in at least two (2)
				  views (typically posterior/anterior and lateral or oblique) demonstrating final
				  needle placement and depth AND disbursement of contrast (when not
				  contraindicated). These images must be available upon request (with appropriate
				  HIPAA compliance) by payers, or reimbursement may be denied.
Fluoroscopy will be reimbursed for the following codes:
				  27096, 62321, 62323, 64479-64484, 64490-64495, 64600-64681, 64633-64636.
B.
Reimbursement for
				Injection/Destruction Procedures
1.
				Facet injections and medial branch blocks are reimbursed at a maximum of three
				(3) total anatomic joint levels. Additional level or bilateral modifiers may be
				used to allow up to a maximum of two (2) additional service levels for facet or
				medial branch blocks in the cervical/thoracic (64491 and 64492) or lumbar
				(64494 and 64495) for a maximum of three (3) procedure levels reimbursed per
				treatment session or day. These procedures are unilateral by definition.
				Bilateral modifiers may be used when nerves are treated bilaterally.
				Reimbursement of the bilateral modifier is twenty five percent (25%) of the
				base amount for the second or contralateral side for procedures listed in the
				Pain Management section.
2. Nerve
				destructive procedures are reimbursed for a maximum of two (2) anatomical
				levels.
3. Reimbursement for
				injection/destruction procedure codes is made on the basis of joint levels, not
				nerves treated (e.g., destruction by neurolytic agent of the L4-L5 facets
				counts as one (1) level/nerve and should be billed as 64635 (first
				level/nerve)). There are two nerves supplying each joint but reimbursement is
				based upon joint(s) treated, not the nerves treated. This applies to CPT codes
				64635, 64636 (lumbar), and 64633, 64634 (cervical/thoracic). These procedures
				are unilateral by definition. Bilateral modifiers may be used when nerves are
				treated bilaterally. Reimbursement is twenty five percent (25%) of the base
				amount for the second or contralateral side when the bilateral modifier is used
				for procedures listed in the Pain Management section.
4. A maximum of two (2) levels of
				transforaminal epidural steroid injections or one level bilaterally are
				reimbursable for a given date of service. This applies to codes 64479, 64480,
				64483, and 64484.
5. A maximum of
				one (1) interlaminar epidural steroid injection is reimbursable for a given
				date of service. This applies to codes 62320 and 62322.
6. If a patient with bilateral pain receives
				only unilateral treatment on a given date of service, any similar procedures
				(same CPT codes) performed on the contralateral side within ninety (90) days of
				the initial procedure will be subject to reimbursement reductions related to
				modifiers for bilateral treatment on the same date of service. For example, if
				a person undergoes a right sided medial branch block(s) or neurotomy(ies) on a
				given date of service, any similar procedure(s) on the left side will be
				subject to the reductions in reimbursement related to use of the bilateral
				modifier if this treatment is provided within ninety (90) days of the date of
				service of the right sided procedures. This rule applies to professional and
				facility reimbursement.