Medical Administrative Contractors To Begin Reviewing Facet Joint Intervention Procedure Payments

On March 22, 2023, the US Department of Health and Human Services (HHS) Office of the Inspector General (OIG) recommended that CMS direct Medicare administrative contractors 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 to $62.2 million worth of facet joint interventions. This estimate was derived from auditing 120 claims. The OIG audit found that 54 of the 120 claims complied with Medicare requirements, and 66 did not. In addition, 33 sessions were found to be improperly coded as therapeutic facet joint injections instead of diagnostic facet joint injections.

While this clawback impacts relatively few physicians, ISASS will continue monitoring this issue and its impact on spine practices.

To see the full OIG report see here: OIG Facet Joint Audit Letter