16.89C

Base Rate – $105.95
Name – Percutaneous facet joint injection – Thoracic

Category – M+ Designated Minor Procedure

Fee Modifiers

Type Code # of calls Explicit Action Amount
CALL
CALL
TRAY
SURC
SURC
SURC
SURC
LVP
NBRSER
NBRSER
MINT
EV
NTAM
NTPM
WK
LVP75

 2 – 4 
  
  
  
  
  
 
 
  
  
 Yes 
 Yes 
 Yes 
 Yes 
 Yes
For Each Call Pay Base At
For Each Call Pay Base At
Increase By
Increase By
Increase By
Increase By
Increase By
Reduce Base To
100%
75%
$13.04
$48.70
$116.83
$116.83
$48.70
75%

II – Operations On The Nervous System

/ 16 Operations On Spinal Cord And Spinal Canal Structures

// 16.8 Invasive diagnostic procedures on spinal cord and spinal canal structures

/// 16.89 Other invasive diagnostic procedures on spinal cord and spinal canal structures

//// 16.89C


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