Looking at the policy bulletin for Aetna http://www.aetna.com/cpb/medical/data/1_99/0016.html under the policy history if you click on the last review 5/14/10 it states
"This CPB is revised to state that facet injections are considered medically necessary for diagnosis of facet-mediated back pain. This CPB is revised to state that facet injections are considered experimental and investigational as a treatment for back pain"

I believe that's why you're getting denied now. The review did not change the policy. Under clinical policy they are reserving the right to decide to pay on experimental based on a case by case approach.


Aetna considers any of the following injections or procedures medically necessary for the treatment of back pain; provided, however, that only one invasive modality or procedure will be considered medically necessary at a time.

Facet joint injections are considered medically necessary in the diagnosis of facet pain in persons with chronic back or neck pain (pain lasting more than 3 months despite appropriate conservative treatment).

Facet joint injections are considered experimental and investigational as therapy for back and neck pain and for all other indications.

A set of facet joint injections means up to 6 injections per sitting, and this can be repeated once to establish the diagnosis. It is not considered medically necessary to repeat facet joint injections more frequently than once every 7 days. Additional sets of facet injections are considered experimental and investigational because they have no proven value.

I don't know if that helps you but this is what I got out of their policy now I don't know if it's one a year or what their limits are that's where I would call and ask also ask for a review.

Karen Habel, CDA, CMBSI, CDBSI

Nothing I say shall be construed as legal advice; always check with your own financial or legal advisors for your specific situation.