Your patients are our members. They deserve safe, effective, clinically evidenced care that brings them real benefit and value.
For this reason, we’ve commissioned a series of independent evidence reviews to understand the benefits of image guidance in peripheral injection into joint.
You can read the current reviews below. We’ve commissioned further evidence reviews which we’ll add here in due course.
Evidence for peripheral injection into:
Expected practice
Image guidance for peripheral joint injection (billed, for example, under CCSD code W9030*) adds hundreds of pounds to patients’ claims.
To justify this extra cost, there must be value for our members.
As the treating specialist, you're responsible for the care you offer our members. However, we'd like you to bear in mind the evidence we present here when considering whether injections under image guidance offer real benefit to your patients.
Following this evidence, we have identified procedures where, from 1 December 2023, we expect not to pay more than for a procedure carried out without image guidance. We state these procedures below.
This decision follows our rules for authorising and funding care, which state: 'Eligible treatment’ is treatment of a disease, illness or injury where that treatment does not cost more than an equivalent treatment that delivers a similar therapeutic or diagnostic outcome.
We're telling AXA Health recognised orthopaedic surgeons about this evidence and we expect to see an overall fall in the number of image guided peripheral injections into joint offered to our members.
We’re also discussing the use of image guided injections with the hospitals in our network.
Based on these reviews, we support the following practice. (See footnotes for affected CCSD codes.)
Knees
Our expectation is that we’ll no longer pay extra for image guided injection into knee, except in the specific circumstances outlined in the summary conclusion to the above evidence review.
We’ll put a note on our Schedule of Procedures and Fees to this effect.
We’ll continue to fund, in full, non-image guided peripheral injections into knee, as a treatment that offers benefit and value to our members.
Where you feel image guided injection into knee is indicated, please contact us to request a Billing Principles exemption.
Shoulders
Our expectation is that we won't pay extra for image guided injections into the subacromial space.
We'll put a note on our Schedule of Procedures and Fees to this effect.
However, we’ll continue to support their judicious use in other circumstances, including:
- injection for osteoarthritis of the acromioclavicular joint,
- injection for osteoarthritis of the glenohumeral joint,
- long head of biceps, and
- shoulder distension for frozen shoulder.
Hips
Our expectation is that we won't pay extra for image guided injections into the hip bursae.
We'll put a note on our Schedule of Procedures and Fees to this effect.
However, we’ll continue to support their judicious use in other circumstances, including including intra-articular, ultrasound guided injections for hip osteoarthritis.
General provisions
Our members are covered for up to three peripheral injections into joint, of any licensed, clinically appropriate, injectable substance, of a similar cost to corticosteroid.
We expect to see a fall in referrals to radiologists for image guided injection.
Which treatments do we fund?
This is what we tell our members about which treatments we fund:
- Your membership covers ‘eligible treatment’.
- ‘Eligible treatment’ is treatment of a disease, illness or injury where that treatment:
- falls within the benefits of this plan and is not excluded from cover by any term in this handbook; and
- is of an acute condition and
- is conventional treatment and
- has been proven to be effective and safe and
- is not preventative and
- does not cost more than an equivalent treatment that delivers a similar therapeutic or diagnostic outcome; and
- is not provided or used primarily for the convenience or financial or other advantage of you or your specialist or other health professional.
Treatment needs to meet all of these requirements.
In addition:
- We publish a Patient Safety Tool which summarises the levels of evidence we require to authorise treatments.
- Section 3.2 of our Billing Principles also defines which treatments we fund.
- You’ll find the fees we pay for these procedures on our Schedule of Procedures and Fees.
Notes: CCSD codes in scope
* Image guided injections
- W9030 Injection(s) +/- aspiration, into joint, cyst, bursa with image guidance – unilateral
- W9035 Injection(s) +/- aspiration, into two or more joints, cysts, bursae with image guidance – bilateral
- W9032 Injection of viscosupplement into joint with image guidance – unilateral
- W9033 Injections of viscosupplement into joints with image guidance – bilateral
** Non-image guided injections
- W9040 Injection(s) +/- aspiration, into joint, cyst, bursa – unilateral
- W9045 Injection(s) +/- aspiration, into two or more joints, cysts, bursae – bilateral
- W9042 Injection of viscosupplement into joint – unilateral
- W9043 Injections of viscosupplement into joints – bilateral