Florida Medicaid’s Covered Services and HCBS Waivers
Pain Management Services
Medicaid reimburses for pain management services to provide for the treatment of pain using nerve blocks or steroid injection.
Medicaid reimburses for pain management services including:
- Up to 12 facet joint injections, with or without steroids, performed under fluoroscopic guidance for the treatment of acute and chronic neck and low back pain in a six month period, per recipient, for the following:
- Up to four percutaneous radiofrequency neurolysis for long-term pain relief in a four month period, per recipient, when all of the following are met:
- Neuroplasty
- Diagnostic trial to determine the origin of pain
- Therapeutic injection when conservative treatment (oral medications, rest and limited activity, or physical therapy) has failed
- Low back or neck pain is suggestive of facet joint origin as documented in the recipient’s history, physical and radiographic evaluations
- Pain has failed to respond to conservative management (oral nonsteroidal anti-inflammatory medications, rest and limited activity, or physical therapy) as documented in the medical record
- A diagnostic temporary block and injections with local anesthetic of the facet nerve (medial branch block) under fluoroscopic guidance into the facet joint has resulted in at least fifty percent reduction in pain
- A minimum of six months has elapsed since prior percutaneous radiofrequency neurolysis treatment
This service is one of the minimum covered services for all Managed Medical Assistance plans serving Medicaid enrollees.
Eligibility
Florida Medicaid recipients requiring medically necessary pain management services.
Resource Information
Information on Medicaid health plans and services is available on the Statewide Medicaid Managed Care webpage.
The Florida Medicaid coverage policies, fee schedules, and Rule are available on the Agency Website.
