Below are Cigna, Aetna, and United Healthcare’s medical policies. All require fluoroscopy when performing facet/medial branch blocks.
You Need to review local coverage determination policy of Medicare Carrier in geographical area and BCBS in geographical area for their policies.
“Facet joint injections/medial branch blocks should be performed using fluoroscopy. Performance of facet joint injections/medial branch blocks without the use of fluoroscopic guidance is considered not medically necessary.”
cignaguidelines/guideline_ downloads/eviCore%20Final% 20CMM-201%20Facet%20Joint% 20Injections_Clean.pdf
“Aetna considers ultrasound guidance of facet injections experimental and investigational because of insufficient evidence of its effectiveness.”
“The use of ultrasound guidance for epidural steroid injection(s) and facet joint injection(s) is unproven and not medically necessary. There is insufficient clinical evidence regarding its safety and/or efficacy in published peer-reviewed medical literature. The available published evidence for ultrasound guidance for epidural and facet injections is limited to a small feasibility study and a cadaver study.”