Facet Joint Intervention Payment Clawback

On March 22, 2023, the US Department of Health and Human Services (HHS) Office of Inspector General (OIG) recommended that the Centers for Medicare & Medicaid Services (CMS) direct the Medicare Administrative Contractors (MACs) to recover improperly paid facet joint intervention payments.

A recent OIG audit found that from August 1 through October 31, 2021, Medicare may have improperly paid physicians an estimated $29.6 million for $62.2 million worth of facet joint interventions. This estimate was derived from auditing 120 sessions — of which 54 complied with Medicare requirements, and 66 did not. In addition, the report found that 33 sessions were improperly coded as therapeutic facet joint injections instead of diagnostic facet joint injections.

MACs have been instructed to recover $18,084 in improper payments from the sample group and develop better training programs to disseminate Medicare requirements. While this clawback impacts relatively few physicians, SIS will continue monitoring this issue and keep you apprised as information is released.

Perplexed about coding requirements and how to properly code your practice's procedures? Read this FAQ on Facet Joint Interventions🔒. Additionally, IPSIS members are always welcome to submit coding questions here 🔒.

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