20 Miss. Code. R. 2-VII

Current through December 10, 2024

Section 20-2-VII - PAIN MANAGEMENT CRITERIA

A. All Interventional Pain Management (IPM) procedures must be billed with the appropriate CPT codes and modifiers (where applicable) using accepted ICD-10-CM codes as the indications for the procedures. Providers MUST use acceptable codes in order to initiate or maintain treatment. Failure to do so is cause for denial of treatment until the proper appropriate codes are submitted.

Payers/URs must use the rules of this Fee Schedule to deny requested treatment. Failure to cite the specific section of the IPM portion of the Mississippi Workers' Compensation Medical Fee Schedule will result in automatic adjudication for the provider without appeal. "Specific" refers to citing the actual section, and appropriate subsections directly from the guidelines. Failure to have the Fee Schedule available during the review would make such citation unachievable, resulting in automatic adjudication for the provider. No outside guidelines can be used to deny IPM care requested in accordance with the Fee Schedule.

B.Injection/Destruction Procedures Multiple Epidural Injections in a Single Treatment Day/Session. Reimbursement is limited to one epidural injection in a single treatment day/session, unless appropriate documentation is entered into the medical record of a medical condition for which multiple injections would be appropriate. These conditions include:

1. Disc pathology (e.g., protrusion) at one level with a dermatomal pain distribution of an adjacent level (e.g., disc affects the traversing nerve root, such as an L4/5 disc herniation affecting the traversing L5 nerve root).

2. Multiple dermatomal nerve root involvement.

3. Bilateral radicular pain.

C.Refill of Pain Pumps Intrathecal Drug Delivery. This method of delivery requires prior authorization. Specific brands of infusion systems have been FDA approved for the following: chronic intraspinal (epidural and intrathecal) infusion of preservative-free morphine sulfate sterile solution in the treatment of chronic intractable pain, chronic infusion of preservative-free ziconotide sterile solution for the management of severe chronic pain, and chronic intrathecal infusion of baclofen for the management of severe spasticity.

1.Description: This mode of therapy delivers small doses of medications directly into the cerebrospinal fluid.

2.Complications: Intrathecal delivery is associated with significant complications, such as infection, catheter disconnects, CSF leak, arachnoiditis, pump failure, nerve injury, and paralysis. Typical adverse events reported with opioids (i.e., respiratory depression, tolerance, and dependence), or spinal catheter-tip granulomas that might arise during intrathecal morphine or hydromorphone treatment have not currently been recorded for ziconotide

3.Indications: Clinical studies are conflicting, regarding long-term, effective pain relief in patients with non-malignant pain. The Division does not generally recommend the use of intrathecal drug delivery systems in injured workers with chronic pain. Due to the complication rate for long-term use, it may be considered only in very rare occasions when dystonia and spasticity are dominant features or when pain is not able to be managed using any other non-operative treatment. This treatment must be prior authorized and have the recommendation of at least one physician experienced in chronic pain management in consultation with the primary treating physician. The procedure should be performed by physicians with documented experience. This small eligible sub-group of patients must meet all of the following indications:

a. A diagnosis of a specific physical condition known to be chronically painful has been made on the basis of objective findings;

b. All reasonable surgical and non-surgical treatment has been exhausted including failure of conservative therapy including active and/or passive therapy, medication management, or therapeutic injections;

c. Pre-trial psychiatric or psychological evaluation has been performed (as for SCS) and has demonstrated motivation and long-term commitment without issues of secondary gain. Significant personality disorders must be taken into account when considering a patient for spinal cord stimulation and other major procedures;

d. There is no evidence of current addictive behavior. (Tolerance and dependence to opioid analgesics are not addictive behaviors and do not preclude implantation); and

e. A successful trial of continuous infusion by a percutaneous spinal infusion pump for a minimum of twenty-four (24) hours. A screening test is considered successful if the patient (a) experiences a fifty percent (50%) decrease in pain, which may be confirmed by VAS, and (b) demonstrates objective functional gains or decreased utilization of pain medications. Functional gains should be evaluated by an occupational therapist and/or physical therapist prior to and before discontinuation of the trial.

4. Contraindications: Infection and body size insufficient to support the size and weight of the implanted device. Patients with other implanted programmable devices should be given these pumps with caution since interference between devices may cause unintended changes in infusion rates.

D.Diagnostic Injections and Procedures

1. Valid diagnostic injections require an appropriately alert patient capable of adequately determining the amount or level of pain relieved or produced by the procedure. This requires judicious use of sedatives in the performance of such procedures. Additional analgesic medications such as intravenous narcotics are to be avoided during the procedure and evaluation phase of testing, as these medications can affect the validity of such diagnostic tests. The results of the tests and drugs used during the injection or procedure must be part of the medical records, and available for review by the payer. Failure to document the patient's response to a diagnostic procedure or injection, and the level of alertness following the procedure or injection, could result in denial of reimbursement. Affected diagnostic procedures include but are not limited to discography and medial branch blocks, diagnostic sacroiliac injections and selective nerve root blocks (billed with epidural codes).

2. Diagnostic injections with local anesthetics require documentation of analgesic response through any validated pain measurement test or scale (e.g., numerical pain scale, visual analogue scale). This should be performed in the treatment facility after the procedure during the time that there would be an expected analgesic response (every thirty (30) minutes for at least one (1) hour). This must be documented and the documentation must be available to the payer for review. Subsequent pain scores must be documented at least hourly for two (2) additional hours after the procedure. If the patient's pre-procedure pain was determined by provocative exam tests or maneuvers, these should be repeated during the evaluation period following the procedure, to differentiate analgesia related to the procedure from positional analgesia (pain improvement), such as, that which may be provided by lying in a recovery bed.

3. Other injections with both therapeutic and potentially diagnostic benefit, such as selective nerve root, peripheral nerve blocks, sympathetic blocks or therapeutic facet injections, would ideally be performed with minimal sedation and avoidance of intravenous narcotics. However, as these injections also have potential therapeutic benefit, this is not a requirement for reimbursement.

E.Epidural Injections

1.Epidural Injections. This Fee Schedule does not recognize a "series" of epidural injections, regardless of number. A trial of epidural injections is permitted provided there is appropriate documentation of a recognized indication for this procedure. Only a single injection can be approved unless there is documentation of analgesic response consistent with response to the injection. Further injections require a positive analgesic response in order to be repeated. For the first injection, the initial analgesic response may be temporary, but cannot be attributed solely to a local anesthetic effect or intra-procedural sedation (i.e., relief for the first few hours after injection). Additionally, in order to repeat an epidural injection, there must be continued radiating pain, and not only residual axial (back/neck) pain.. After the second injection, there must be a residual and progressive analgesic benefit in order to perform a third injection. Documentation of a positive patient response will be required to continue epidural treatment. If there is no documented residual pain relief after two (2) injections, no further epidural injections will be considered medically necessary.

a. Repeat injections (up to two (2) additional injections, for a total of three (3) per twelve (12) month period), however, do NOT require prior approval as long as the appropriate responses are properly documented.

b. Utilization management or review decisions shall not be based solely on the application of clinical guidelines, but must include review of clinical information submitted by the provider and represent an individualized determination based on the worker's current condition and the concept of medical necessity predicated on objective or appropriate subjective improvements in the patient's clinical status.

2. Interlaminar epidural injections are seldom used for diagnostic purposes because the generalized regional spread of local anesthetic with spinal injection makes it impractical if not impossible to selectively block a specific nerve.

3. To be reimbursed, both cervical and interlaminar epidural steroid injections must be performed fluoroscopically, typically with contrast injection, unless there is a documented contrast allergy.

Epidural blood patches do not require fluoroscopic guidance, though this is preferred.

The specific cause of radiating pain may not always be obvious on imaging, such as MRI, CT or x-rays. Therefore, the indications for a trial of epidural steroid injections are based on the patient's clinical presentation, not imaging.

All nerve root pain or radiating pain is not caused by damage (nerve or axon loss) to the nerve or dorsal root ganglion.

When there is only inflammation or irritation of the nerve, there may be radiating pain in the absence of physical exam findings of nerve damage such as altered or absent motor, sensory, or reflex function. Actual nerve damage is not treated by steroid injections, as steroids do not accelerate the regeneration of new nerve tissue (axon) regeneration. Therefore, demonstrable weakness, reflex changes and sensory loss are not necessary as an indication for a trial of epidural steroids. Similarly, EMG/NCV testing demonstrating nerve or axon loss is not necessary as an indication for a trial of epidural steroid injections.

A trial of epidural steroids injections may be indicated when there is radiating pain (extremity or buttock) with or without co-existing back pain.

4.Initiation and Continuation of Epidural Injections. Prior approval by the payer or utilization reviewer is required before initiating a trial of epidural injections. It is NOT necessary to obtain prior approval to repeat an injection as long as a positive analgesic response (pain improvement or functional improvement) to the previous injection is reported.

Repeat trials of epidural injections may be considered for reimbursement after one (1) year if the preceding trial provided several months of demonstrable benefit. In order to be considered effective, this benefit must include greater than thirty percent (30%) improvement in pain scores, and documentation of either 1) significant reduction of daily narcotic consumption, defined as a sustained reduction (several months) of at least thirty percent (30%) of the daily narcotic use prior to initiation of the trial of epidural injections, or 2) ability to work for a sustained period of time (several months) at least at sedentary work level or the work level as determined by a valid Functional Capacity Rating (FCE). No patient can be considered for a repeat trial of epidural steroid injections, if after the preceding trial (in a similar anatomical area) they are unable to reduce narcotic consumption to less than 100 mg morphine equivalent per day.

If, after an initial trial of epidural injections, it is suspected that there is a new nerve injury involving a different anatomical nerve, a trial of epidural injections may be indicated independent of the response to the initial trial of epidural injections. However, as this would represent a separate nerve injury, causation would have to be established prior to initiation of further treatment related to a work injury.

5.Documentation Requirements for Epidural Injections (Adopted and Adapted from CMS MLN Matters #SE1102 rev). Documentation in the medical record must contain the initial evaluation including history and physical examination; diagnosis, pain, and disability of moderate to severe degree; site of injection with name and dosage of drug instilled; and the patient's response to the prior injections.

A. Documentation of conservative therapies that were tried and failed except in acute situations such as acute disc herniation with disabling and debilitating pain, reflex sympathetic dystrophy, postoperative and obstetric pain and intractable pain secondary to carcinoma.

B. All documentation must be maintained in the patient's medical record and available to the payer upon request.

C. The record must be legible and include appropriate patient identification information (e.g., complete name, dates of service(s)). The record must include the physician responsible for and providing the care of the patient.

D. The submitted medical record should support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code should describe the service performed.

E. The patient's record should document an appropriate history and physical examination by the provider or provider's representative specifying the medical indications requiring his/her presence when applicable. The indications should be recorded by the provider performing the injection in their respective notes.

Seehttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1102.pdf [File Link Not Available]

F.Facet Injections. Intra-articular joint injections (cervical, thoracic, lumbar), which can have both diagnostic and therapeutic indications, should always be considered primarily therapeutic.

The number of facet injections subject to Reimbursement for facet injections is limited to four (4) dates of service with a maximum of two (2) therapeutic and two (2) diagnostic injections for the initial twelve (12) month period of treatment per anatomical region. This allows for a total of four (4) dates of service, regardless of the number of levels treated, which levels are treated, or which side (left or right or bilateral) is treated, in the same anatomical region. If treatment for facet-related pain continues past twelve (12) months, further injections are limited to a total of two (2) dates of service per twelve (12) month period. Facet injections in different anatomical areas are not subject to these limits, as each anatomical area would be subject to its own separate limit. Nerve-destructive procedures (e.g. radiofrequency facet nerve neurotomy, codes 64633, 64634, 64635, 64636) are not considered additional therapeutic procedures for the purpose of this rule.

A "different anatomical area" refers to the lumbar, thoracic, and cervical areas. Injections within the lumbar spine, for example, are considered to be within the same anatomical area regardless of the actual lumbar joint/nerve level, or which side (right or left), is treated, and all limits would apply in this anatomical area.

In order to be a "successful" ("positive") diagnostic facet procedure (either intra-articular or medial branch block(s)), the patient must experience at least seventy-five percent (75%) relief of the index pain (pain being treated by the procedure). Additionally, this index pain must be at least fifty percent (50%) of the patient's total pain.

Cervical, upper/lower thoracic or lumbar nerves facet nerve (medial branch ablation will be reimbursed once per seven (7) month period. Repeat (medial branch) ablation is contingent upon documentation of at least six (6) month's measurable (greater than thirty percent (30%) improvement in pain scores), and documentation of either 1) reduction of daily narcotic consumption of at least thirty percent (30%) from the daily use noted prior to the procedure, or 2) ability to work at least at a light duty work level or work level as determined by a valid Functional Capacity Evaluation (FCE). No patient will be considered for a repeat neuroablative procedure (e.g., neurotomy) if after the preceding neuroablative procedure (at similar anatomical levels) they are unable to reduce narcotic consumption to less than 100 mg morphine equivalent per day.

A repeat therapeutic facet joint injection (cervical, thoracic, or lumbar; codes 64490-64495) will be considered for reimbursement if there is documentation of a significant analgesic response that persists for at least three (3) months. This relief must be at least fifty percent (50%) of the pain in the specific anatomical area targeted by the injection, and there must be documentation of a durable (three (3) months) measurable improvement in the range of motion, or documentation of normal motion, of the involved joint area being treated.

G.Trigger Point Injections. The goal is to treat the cause of pain, not just the symptoms. With this intent, in order to be repeated in the same muscle group, there must be at least a fifty percent (50%) persistent benefit from the previous injection. For patients not in therapy, trigger point injections can be performed monthly, as long as there is a documented fifty percent (50%) residual benefit, and progressive relief (pain intensity and duration of relief) with the preceding injection. After six months, if similar pain persists, the patient should be re-evaluated regarding the etiology of the complaint, and the available treatment options reconsidered. The payer may consider payment for additional trigger point injections upon review.

H.Soft Tissue Injections. "Myofascial," "myoneural," and "trigger point injections" are synonymous and are to be reimbursed with code 20552 or 20553. Modifiers for additional injections are not allowed with these codes. Reimbursement will be made for 20552 or 20553 but not both on the same date.

CPT codes 20550 and 20551 are used for injections of tendon origins and are not to be used for "myofascial, myoneural or trigger point" injections.

Code 20612 is used for the aspirations/injection of a ganglion cyst and not for "myofascial, myoneural, or trigger point" injections.

I.Sacroiliac (SI) Joint. Sacroiliac joint injections (code 27096) require documentation of at least a six (6) week durable analgesic benefit of at least fifty percent (50%) pain relief in the anatomical area being targeted by the injection. A maximum of two (2) therapeutic sacroiliac joint injections can be reimbursed per twelve (12) month periodper joint injected, and not the contralateral joint (i.e., right or left sided joint).

J. Lumbar provocative discography is medically necessary for evaluation for disc pathology in persons with persistent, severe low back pain (LBP) and abnormal interspaces on magnetic resonance imaging (MRI), where other diagnostic tests have failed to reveal clear confirmation of a suspected disc as the source of pain, and surgical intervention is being considered. Lumbar provocative discography is not covered for all other indications. Functional anesthetic discography (involving injection of anesthetic directly into the disc) is not covered.

K.Botulinum Toxin. Botulinum toxin is not indicated for the relief of musculoskeletal pain, and its use as such is not covered by the Fee Schedule. With prior approval, an exception can be made when treatment is indicated for limb spasticity or other indications.

L.Implantation of Spinal Cord Stimulators.

1. The following conditions must be met for consideration of reimbursement for spinal cord stimulators.

2. Patient must have a medical condition for which spinal cord stimulation (SCS) is a recognized and accepted form of treatment.

3. There must be a trial stimulation that includes a minimum seven (7) day home trial with the temporary stimulating electrode.

4. During the trial stimulation, the patient must report functional improvement, decreased use of medications, and at least fifty percent (50%) pain reduction and some functional gains during the last four (4) days of the stimulation trial.

5. Psychological screening must be used to determine if the patient is free from:

a. Substance abuse issues;

b. Untreated psychiatric conditions; and

c. Major psychiatric illness that could impair the patient's ability to respond appropriately to the trial stimulation.

6. Neurostimulation

a. Description: Spinal cord stimulation devices are FDA approved as an aid in the management of chronic intractable pain of the trunk and/or limbs, including unilateral and bilateral pain associated with the following: failed back surgery syndrome, intractable low back pain and leg pain. There is limited evidence that supports its use for spinal axial pain. SCS may be most effective in patients with CRPS I or II who have not achieved relief with oral medications, rehabilitation therapy, or therapeutic nerve blocks, and in whom the pain has persisted for longer than six (6) months. Surgical procedures should be performed by surgeons, usually with a neurosurgical or spinal background.

b. Surgical Indications: Patients with established CRPS I or II or a failed spinal surgery with persistent functionally limiting radicular pain greater than axial pain who have failed conservative therapy including active and/or passive therapy, pre-stimulator trial psychiatric evaluation and treatment, medication management, and therapeutic injections. SCS is not recommended for patients with the major limiting factor of persistent axial spine pain. SCS may be indicated in a subset of patients who have a clear neuropathic radicular pain (radiculitis). The extremity pain should account for at least fifty percent (50%) or greater of the overall back and leg pain experienced by the patient. Prior authorization is required. Patients with severe psychiatric disorders, and issues of secondary gain are not candidates for the procedure.

c. A comprehensive psychiatric or psychological evaluation must be provided prior to the stimulator trial. This evaluation should include a standardized detailed personality inventory with validity scales (such as MMPI-2, MMPI-2-RF, or PAI) pain inventory with validity measures (for example, BHI 2, MBMD); clinical interview and complete review of the medical records. Before proceeding to a spinal stimulator trial the evaluation should find the following:

* No indication of falsifying information, or of invalid response on testing;

* No primary psychiatric risk factors or "red flags" (e.g., psychosis, active suicidality, severe depression, or addiction). (Note that tolerance and dependence to opioid analgesics are not addictive behaviors and do not preclude implantation);

* A level of secondary risk factors or "yellow flags" (e.g., moderate depression, job dissatisfaction, dysfunctional pain conditions) judged to be below the threshold for compromising the patient's ability to benefit from neurostimulation;

* The patient is cognitively capable of understanding and operating the neurostimulation control device;

* The patient is cognitively capable of understanding and appreciating the risks and benefits of the procedure; and

* The patient has demonstrated a history of motivation in and adherence to prescribed treatments.

d. The psychologist or psychiatrist performing these evaluations should not be an employee of the physician performing the implantation. This evaluation must be completed, with favorable findings, before the screening trial is scheduled. Significant personality disorders must be taken into account when considering a patient for spinal cord stimulation and other major procedures.

e. All reasonable surgical and non-surgical treatment has been exhausted.

f. The topography of pain and its underlying pathophysiology are amenable to stimulation coverage (the entire painful extremity area has been covered).

g. Successful neurostimulation screening test: For a spinal cord neurostimulation screening test, a temporary lead is implanted at the level of pain and attached to an external source to validate therapy effectiveness. A screening test is considered successful if the patient meets both of the following criteria:

* Experiences a fifty percent (50%) decrease radicular or CRPS in pain, which may be confirmed by visual analogue scale (VAS) or Numerical Rating Scale (NRS).

* Demonstrates objective functional gains or decreased utilization of pain medications.

* It is expected that there will be an attempt to wean opioid pain medications at least partially prior to the stimulation trial to determine if there was additional pain relief that could be attributed to the stimulator trial.

Objective, measurable, functional gains should be evaluated by an occupational therapist and/or physical therapist and the primary treating physician prior to and before discontinuation of the trial.

M.Topical Drug Delivery

1.Description: Topical medications, such as lidocaine and capsaicin, may be an alternative treatment for neuropathic disorders and is an acceptable form of treatment in selected patients.

2.Indications: Neuropathic pain for most agents. Episodic use of NSAIDs and salicylates for joint pain. Patient selection must be rigorous to select those patients with the highest probability of compliance. Many patients do not tolerate the side effects for some medication or the need for frequent application.

3.Dosing and Time to Therapeutic Effect : All topical agents should be prescribed with strict instructions for application and maximum number of applications per day to obtain the desired benefit and avoid potential toxicity. There is no evidence that topical agents are more or less effective than oral medications. For most patients, the effects of long-term use are unknown and thus may be better used episodically.

4.Side Effects: Localized skin reactions may occur, depending on the medication agent used vs. Topical Agents.

a.Capsaicin. Formulations of capsaicin have been FDA approved for management of pain associated with post-herpetic neuralgia. Capsaicin offers a safe and effective alternative to systemic NSAID therapy. There is also good evidence that a high dose (8%) capsaicin patch applied for 60 minutes can decrease post herpetic neuralgic pain for three (3) months.

b.Ketamine and Tricyclics. Topical medications, such as the combination of ketamine and amitriptyline have been proposed as an alternative treatment for neuropathic disorders including CRPS. However, neither tricyclic nor ketamine topicals are FDA approved for topical use in neuropathic pain. Continued use of these agents beyond the initial prescription requires documentation of effectiveness, including functional improvement, and/or decreased use of other medications, particularly decreased use of opiates or other habituating medications.

c.Lidocaine. Formulations of lidocaine (patch form) have been FDA approved for pain associated with post-herpetic neuralgia.

d.Topical Salicylates and Non-salicylates. These have been shown to be effective in relieving pain in acute musculoskeletal conditions and single joint osteoarthritis. Topical salicylate and non-salicylates achieve tissue levels that are potentially therapeutic, at least with regard to Cyclooxygenase (COX) inhibition. There is good evidence that diclofenac gel reduces pain and improves function in mild-to-moderate hand osteoarthritis. Diclofenac gel has been FDA approved for acute pain due to minor strains, pains, and contusions; and for relief of pain due to osteoarthritis of the joints amenable to topical treatment, such as those of the knees and hands.

e.Other Compounded Topical Agents. At the time this guideline was written, no studies identified evidence for the effectiveness of compounded topical agents other than those recommended above. Therefore, other compounded topical agents are not recommended.

5. Prior authorization is required for all agents that have not been recommended above. Continued use requires documentation of effectiveness including functional improvement and/or decrease in other medications.

N.Use of Controlled Substances

Use of Opioids or Other Controlled Substances for Management of Chronic (Non-Terminal) Pain. Optimal, effective treatment for chronic pain may require the use of opioids or other controlled substances. The proper and effective use of opioids or other controlled substances has been specifically addressed by the Mississippi Board of Medical Licensure. Unless otherwise directed by the MWCC, reimbursement for prescriptions for opioids or other controlled substances used for the management or treatment of chronic, non-terminal pain shall not be provided under this Fee Schedule unless treatment is sufficiently documented and complies with the Rules and Regulations, as promulgated by the Mississippi State Board of Medical Licensure, and supplemented by the MWCC accordingly.

In addition to the specific Rules and Regulations promulgated by the Mississippi State Board of Medical Licensure, the payer may, as in other cases, obtain a second opinion from an appropriate and qualified physician to determine the appropriateness of the treatment being rendered, including but not limited to the appropriateness of the continuing use of opioids or other controlled substances for treatment of the patient's chronic pain. However, any such second opinion shall not be used as the basis for abrupt withdrawal of medication or payment thereof. Nothing in this paragraph shall prohibit a physician from administering narcotic drugs to a person for the purpose of relieving acute withdrawal symptoms when necessary while arrangements are being made for referral or discontinuance of treatment, and the payer shall provide reimbursement in accordance with this Fee Schedule, as follows: not more than one (1) day's medication may be administered to the person or for the person's use at one time. Such emergency treatment may be carried out for not more than three (3) days. Discontinuance of treatment or reimbursement of prescriptions based on a second opinion obtained hereunder shall be subject to review by the MWCC pursuant to the Dispute Resolution Rules set forth in the Dispute Resolution Rules section in this Fee Schedule.

See the MWCC website for Guidelines for the Prescription of Opiates athttps://www.mwcc.ms.gov/pdf/mwccGuidlinesForThePrescriptionOfOpiates.pdf [File Link Not Available]

Code	Description	Amount	PC Amount	TC Amount	FUD	Assist Surg	APC Amount
01996	DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN	see page 80	XXX	N
20526	INJECTION THERAPEUTIC CARPAL TUNNEL	264.00	000	N	351.42
20550	INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS	181.20	000	N	351.42
20551	INJECTION SINGLE TENDON ORIGIN/INSERTION	183.60	000	N	351.42
20552	INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES	188.40	000	N	351.42
20553	INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES	217.20	000	N	351.42
20600	ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US	165.60	000	N	351.42
20604	ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT	252.00	000	N	351.42
20605	ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US	172.80	000	N	351.42
20606	ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US	278.40	000	N	850.31
20610	ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US	205.20	000	N	351.42
20611	ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US	313.20	000	N	351.42
20612	ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ	205.20	000	N	351.42
27096	INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA	547.20	000	N
62263	PRQ LYSIS EPIDURAL ADHESIONS MULT SESS 2/> DAYS	2054.40	010	N	1086.07
62264	PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY	1466.40	010	N	1086.07
62270	SPINAL PUNCTURE LUMBAR DIAGNOSTIC	506.40	000	N	850.31
62272	SPINAL PUNCTURE THER DRAIN CEREBROSPINAL FLUID	668.40	000	N	850.31
62273	INJECTION EPIDURAL BLOOD/CLOT PATCH	591.60	000	N	850.31
62280	INJX/INFUSION NEUROLYTIC SUBSTANCE SUBARACHNOID	1134.00	010	N	1086.07
62281	INJX/INFUS NEUROLYT SUBST EPIDURAL CERV/THORACIC	832.80	010	N	1086.07
62282	INJX/INFUS NEUROLYT SBST EPIDURAL LUMBAR/SACRAL	1035.60	010	N	1086.07
62290	INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR	1154.40	000	N
62291	INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC	1113.60	000	N
J1	62350	IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM	1380.00	010	N	8627.34
62355	RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH	927.60	010	N	2316.70
J1	62360	IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS SUBQ RSVR	1095.60	010	N	26058.10
J1	62361	IMPLTJ/RPLCMT FS NON-PRGRBL PUMP	1495.20	010	N	26058.10
J1	62362	IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP	1324.80	010	N	26058.10
62365	RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS	1022.40	010	N	6483.81
62367	ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL	136.80	XXX	N	398.18
62368	ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG	188.40	XXX	N	398.18
62369	ELECT ANLYS IMPLT ITHCL/EDRL PMP W/REPRG&REFIL	400.80	XXX	N	398.18
62370	ELEC ANLYS IMPLT ITHCL/EDRL PMP W/REPR PHYS/QHP	416.40	XXX	N	398.18
J1	63650	PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL	1077.15	010	N	10355.35
63661	RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR	2101.20	010	Y	2316.70
63662	RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR	2928.00	090	Y	4089.32
J1	63663	REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR	2812.80	010	Y	10355.35
J1	63664	REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR	3034.80	090	Y	29514.29
J1	63685	INSJ/RPLCMT SPI NPGR DIR/INDUXIVE COUPLING	1248.00	010	Y	43809.69
63688	REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR	1287.60	010	N	4089.32
64400	NJX ANES TRIGEMINAL NRV ANY DIV/BRANCH	465.60	000	N	351.42
64402	INJECTION ANESTHETIC AGENT FACIAL NERVE	514.80	000	N	151.20
64405	INJECTION ANESTHETIC AGENT GREATER OCCIPITAL NRV	284.40	000	N	351.42
64408	INJECTION ANESTHETIC AGENT VAGUS NERVE	402.00	000	N	351.42
64410	INJECTION ANESTHETIC AGENT PHRENIC NERVE	531.60	000	N	1086.07
64413	INJECTION ANESTHETIC AGENT CERVICAL PLEXUS	432.00	000	N	850.31
64415	SINGLE NERVE BLOCK INJECTION ARM NERVE	405.60	000	N	1086.07
64416	INJECTION ANES BRACHIAL PLEXUS CONT NFS CATH	273.60	000	N	1086.07
64417	INJECTION ANESTHETIC AGENT AXILLARY NERVE	451.20	000	N	1086.07
64418	INJECTION ANESTHETIC AGENT SUPRASCAPULAR NERVE	325.20	000	N	850.31
64420	INJECTION ANESTHETIC AGENT 1 INTERCOSTAL NERVE	378.00	000	N	850.31
64421	MULTIPLE NERVE BLOCK INJECTIONS RIB NERVES	535.20	000	N	1086.07
64425	INJECTION ANES ILIOINGUINAL ILIOHYPOGASTRIC NRVS	471.60	000	N	850.31
64430	INJECTION ANESTHETIC AGENT PUDENDAL NERVE	496.80	000	N	1086.07
64435	INJECTION ANESTHETIC PARACERVICAL UTERINE NERVE	480.00	000	N	850.31
64445	INJECTION ANESTHETIC AGENT SCIATIC NRV SINGLE	466.80	000	N	850.31
64446	INJECTION ANES SCIATIC NERVE CONT INFUSION CATH	273.60	000	N	1086.07
64447	INJECTION ANESTHETIC AGENT FEMORAL NERVE SINGLE	415.20	000	N	850.31
64448	INJECTION ANES FEMORAL NERVE CONT INFUSION CATH	246.00	000	N	1086.07
64449	INJECTION ANES LUMBAR PLEXUS POST CONT NFS CATH	292.80	000	N	1086.07
64450	INJECTION ANES OTHER PERIPHERAL NERVE/BRANCH	262.80	000	N	850.31
64455	NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE	163.20	000	N	351.42
64461	PVB THORACIC SINGLE INJECTION SITE W/IMG GID	475.20	000	N	850.31
+	64462	PVB THORACIC SECOND & ADDL INJ SITE W/IMG GID	264.00	ZZZ	N
64463	PVB THORACIC CONT CATHETER INFUSION W/IMG GID	615.60	000	N	850.31
64479	NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL	834.00	000	N	1086.07
+	64480	NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC EA LV	410.40	ZZZ	N
64483	NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL	772.80	000	N	1086.07
+	64484	NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV	334.80	ZZZ	N
64486	TAP BLOCK UNILATERAL BY INJECTION(S)	374.40	000	N
64487	TAP BLOCK UNILATERAL BY CONTINUOUS INFUSION(S)	538.80	000	N
64488	TAP BLOCK BILATERAL BY INJECTION(S)	459.60	000	N
64489	TAP BLOCK BILATERAL BY CONTINUOUS INFUSION(S)	798.00	000	N
64490	NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL	646.80	000	Y	1086.07
+	64491	NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL	321.60	ZZZ	Y
+	64492	NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL	324.00	ZZZ	Y
64493	NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL	589.20	000	Y	1086.07
+	64494	NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL	298.80	ZZZ	Y
+	64495	NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL	298.80	ZZZ	Y
64505	INJECTION ANES AGENT SPHENOPALATINE GANGLION	403.20	000	N	351.42
64510	NJX ANES STELLATE GANGLION CRV SYMPATHETIC	453.60	000	N	1086.07
64517	INJECTION ANES SUPERIOR HYPOGASTRIC PLEXUS	651.60	000	N	1086.07
64520	INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC	690.00	000	N	1086.07
64530	INJX ANES CELIAC PLEXUS W/WO RADIOLOGIC MONITRNG	687.60	000	N	1086.07
64600	DSTRJ TRIGEMINAL NRV SUPRAORB INFRAORB BRANCH	1482.00	010	N	1086.07
J1	64605	DSTRJ NEUROLYTIC TRIGEMINAL NRV 2/3 DIV BRANCH	2026.80	010	N	3259.45
J1	64610	DSTRJ NEURLYTIC TRIGEM NRV 2/3 DIV RADIO MONITOR	2650.80	010	N	3259.45
64620	DSTRJ NEUROLYTIC AGENT INTERCOSTAL NERVE	709.20	010	N	1086.07
64630	DSTRJ NEUROLYTIC AGENT PUDENDAL NERVE	812.40	010	N	1086.07
64632	DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE	294.00	010	N	351.42
J1	64633	DSTR NROLYTC AGNT PARVERTEB FCT SNGL CRVCL/THORA	1426.80	010	N	3259.45
+	64634	DSTR NROLYTC AGNT PARVERTEB FCT ADDL CRVCL/THORA	640.80	ZZZ	N
J1	64635	DSTR NROLYTC AGNT PARVERTEB FCT SNGL LMBR/SACRAL	1411.20	010	N	3259.45
+	64636	DSTR NROLYTC AGNT PARVERTEB FCT ADDL LMBR/SACRAL	582.00	ZZZ	N
64640	DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE	463.20	010	N	1086.07
64680	DSTRJ NEUROLYTIC W/WO RAD MONITOR CELIAC PLEXUS	1088.40	010	N	1086.07
64681	DSTRJ NULYT W/WORAD MNTR SUPRIOR HYPOGSTR PLEXUS	1971.60	010	N	1086.07
72275	EPIDUROGRAPY RS & I	220.98	70.49	150.49	XXX	N
72285	DISKOGRAPY CERVICAL/THORACIC RS & I	0.00	0.00	0.00	XXX	N	2316.70
72295	DISKOGRAPY LUMBAR RS & I	184.15	78.11	106.04	XXX	N
76942	US GUIDANCE NEEDLE PLACEMENT IMG S & I	102.24	57.79	44.45	XXX	N
+	77002	FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON	181.61	50.17	131.44	ZZZ	N
+	77003	FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON	175.90	54.61	121.29	ZZZ	N
95990	REFILL & MAINTENANCE PUMP DRUG DLVR SPINAL/BRAIN	154.58	XXX	N	409.50
95991	RFL & MAIN IMPLT PMP/RSVR DLVR SPI/BRN PHY/QHP	194.70	XXX	N	351.42

20 Miss. Code. R. 2-VII

Amended 6/14/2017

Amended 6/15/2019