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January 4, 2023

Targeted Probe and Education Program to Focus on Spinal Pain Management Claims

The CGS Targeted Probe and Education program will begin review of claims associated with spinal pain management services. Guidance for spinal pain management services provision and documentation may be found in the CGS’ LCD L39015External Website, LCD L38773External Website and NCD 160.7External PDF.

All spinal pain management services must meet all requirements regarding medical reasonableness and necessity as outlined in the applicable statute, regulations, and manual provisions.

Spinal pain management services must be reasonable and necessary for the treatment of the patient's condition. The appropriate documentation must be kept on file and available upon request.  The spinal pain management service must meet all program coverage criteria in order for payment to be made.

We expect the documentation submitted to include a copy of the following legible and signed documentation from each patient's medical record:

  1. Beneficiary’s name
  2. Date of service
  3. Clinical note:
    • supporting assessment of patient
    • supporting relevant history
    • results of pertinent tests/procedures
    • signed and dated office visit/operative report
    • supporting medical necessity of procedure
  4. For Epidural Steroid Injections
    • films adequately documenting final need position and contrast flow
  5. Appropriate signatures
    • Signature and credentials of person performing the service
    • Amendments/corrections/delayed entries are properly identified
    • Amendments/corrections/delayed entries are initialed and dated by author within 30 days of the billed service.

For additional documentation requirements, please reference:

CPT codes under review will include:

  • 62323- Injection(s), of diagnostic or therapeutic substance(s) with imaging guidance
  • 63650- Percutaneous implantation of neurostimulator electrode array
  • 63685- Insertion or replacement of spinal neurostimulator pulse generator or receiver
  • 64635- Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance, lumbar or sacral, single facet joint
  • 64636- Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance, lumbar or sacral, each additional facet joint

For more information on Targeted Probe and Education, please see the following links:

Consider using the myCGS Portal for claim review status and submission of documentation. For more information, please access myCGS


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