Transforaminal Epidural Injections / Highmark (DE, DCMA, MD, NJ & PA) LCD L27512

Why This Topic Matters

These policies affect whether claims for spinal injection services are supported by the medical record and billed in a way that aligns with the LCD’s requirements. Understanding the article helps reduce claim denials, documentation gaps, and modifier-related billing errors.

Article Sections

1. Specific Documentation Requirements for Transforaminal Epidural and Paravertebral Facet Joint Injections

   This section covers the medical-record documentation expectations associated with these injection services. It addresses the types of supporting information expected before and after the procedure and the need to retain records for review.

2. CPT Code Groupings and Billing Modifiers

   This section outlines the CPT code groups referenced for cervical/thoracic and lumbar/sacral spinal injection services. It also discusses modifier use in relation to unilateral, bilateral, and imaging-related billing situations.