Medicare Benefits Schedule - Note TN.8.245

In the majority of circumstances, thermal radiofrequency should be the modality of choice. Pulsed radiofrequency should only be used in limited cases, such as when an anatomic abnormality precludes the correct positioning of a thermal radiofrequency probe.

Prior to commencing treatment, the patient should be made aware of:

(a) which modality is being used and why;

(b) what longevity of response is expected;

(c) the mechanism involved;

(d) technical details such as the temperature used;

(e) the evidence base for the modality recommended; and

(f) cost

Clear distinctions should be made between thermal (continuous) radiofrequency neurotomy and pulsed radiofrequency of the medial branch of the dorsal rami of spinal nerves for treatment of zygapophyseal pain.

Items 39110, 39111, 39116, 39117, 39118, 39119

There are six MBS items applicable to percutaneous neurotomy (items 39110, 39111, 39116, 39117, 39118 and 39119). The items relate to six regions of the spine (lumbar, thoracic, and cervical divided into left and right sides). These items commenced on 1 March 2022.

Effective 11 April 2022, there are new frequency claiming restrictions for these items.

A patient can now receive percutaneous neurotomy treatment in up to three episodes of care in a 12-month period. An episode of care means one or more percutaneous neurotomy services performed in a single attendance, where clinically relevant.

The percutaneous neurotomy items are claimable per joint treated, not per nerve or lesion.

For compliance purposes, practitioner should record the name of the joint/s that are being treated during an attendance in the patient’s clinical notes.

More than one joint in the same region can be treated and claimed on the same day (i.e. as part of the same episode), and joints in another region can also be treated in the same episode.

The Multiple Operation Rule will continue to apply when more than one joint is being treated in the same episode.

The 12-month period is a rolling period, commencing on the date of the first episode (for treatment provided on or after 11 April 2022), to a maximum of three episodes over the next 12 months. For example, if the first episode of treatment is provided on 20 April 2022, up to two further episodes of treatment can be provided up to 19 April 2023.

Treatment provided under these items from 1 March 2022 to 10 April 2022 (inclusive) will not be counted in the 12‑month period for the patient. 

Treatment of the T12/L1 zygapophyseal joint should be classified as a thoracic region procedure. Accordingly, the thoracic items 39116 or 39117 would be appropriate for such a procedure.

The C7/T1 facet joint is innervated by the medial branches of C7 and C8 (cervical region). Accordingly, the relevant cervical items 39118 or 39119 would be appropriate for such a procedure.

Item 39323

Item 39323 is limited to 6 services for a given nerve per 12-month period. The 12-month period will start from the first time the item has been claimed on or after 1 March 2022 and will continue on a rolling 12-month basis.

For compliance purposes, the applicable nerve name must be documented in the patient record and noted on Medicare claims for item 39323 e.g. ‘39323 - Right Genicular nerve.'

Related Items: 39110 39111 39116 39117 39118 39119 39323

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Multiple Operation Rule

Left cervical percutaneous zygapophyseal joint denervation by radio-frequency probe, or cryoprobe, using radiological imaging control

Applicable to one or more services provided in a single attendance, for not more than 3 attendances in a 12 month period

(Anaes.)

Fee: $360.60 Benefit: 75% = $270.45 85% = $306.55

(See para TN.8.4, TN.8.245 of explanatory notes to this Category)

Multiple Operation Rule

Left lumbar percutaneous zygapophyseal joint denervation by radio-frequency probe, or cryoprobe, using radiological imaging control

Applicable to one or more services provided in a single attendance, for not more than 3 attendances in a 12 month period

(Anaes.)

Fee: $295.00 Benefit: 75% = $221.25 85% = $250.75

(See para TN.8.4, TN.8.245 of explanatory notes to this Category)

Multiple Operation Rule

Right lumbar percutaneous zygapophyseal joint denervation by radio-frequency probe, or cryoprobe, using radiological imaging control

Applicable to one or more services provided in a single attendance, for not more than 3 attendances in a 12 month period

(Anaes.)

Fee: $295.00 Benefit: 75% = $221.25 85% = $250.75

(See para TN.8.4, TN.8.245 of explanatory notes to this Category)

Multiple Operation Rule

Left thoracic percutaneous zygapophyseal joint denervation by radio-frequency probe or cryoprobe using radiological imaging control

Applicable to one or more services provided in a single attendance, for not more than 3 attendances in a 12 month period

(Anaes.)

Fee: $327.85 Benefit: 75% = $245.90 85% = $278.70

(See para TN.8.4, TN.8.245 of explanatory notes to this Category)

Multiple Operation Rule

Right thoracic percutaneous zygapophyseal joint denervation by radio-frequency probe, or cryoprobe, using radiological imaging control

Applicable to one or more services provided in a single attendance, for not more than 3 attendances in a 12 month period

(Anaes.)

Fee: $327.85 Benefit: 75% = $245.90 85% = $278.70

(See para TN.8.4, TN.8.245 of explanatory notes to this Category)

Multiple Operation Rule

Right cervical percutaneous zygapophyseal joint denervation by radio-frequency probe, or cryoprobe, using radiological imaging control

Applicable to one or more services provided in a single attendance, for not more than 3 attendances in a 12 month period

(Anaes.)

Fee: $360.60 Benefit: 75% = $270.45 85% = $306.55

(See para TN.8.4, TN.8.245 of explanatory notes to this Category)

Multiple Operation Rule

Percutaneous denervation (excluding medial branch nerve) by cryotherapy or radiofrequency probe, other than a service to which another item applies, applicable not more than 6 times for a given nerve in a 12 month period 

(Anaes.)

Fee: $304.65 Benefit: 75% = $228.50 85% = $259.00

(See para TN.8.245 of explanatory notes to this Category)