Medicare Releases Proposed LCD on Peripheral Nerve Blocks and Procedures for Chronic Pain, With Elimination of All Peripheral Nerve Blocks from Coverage Policy
Overview of the Medicare Peripheral Nerve Block LCD
Medicare has released a proposed Local Coverage Determination (LCD) that would eliminate coverage for nearly all peripheral nerve block and related procedures for chronic pain.
Who is Affected by the Proposed LCD
The proposed LCDs were released by Medicare Administrative Contractors (MACs) — CGS, NGS, Noridian, Palmetto, and WPS. Together, these MACs oversee 24 states across the country:
NGS: Main, New Hampshire, Vermont, Massachusetts, Rhode Island, Connecticut, New York, New Jersey
Noridian: Alaska, Arizona, California, Hawaii, Nevada, Oregon, Washington
Palmetto: Virginia North Carolina, South Carolina, West Virginia
CGS: Kentucky, Ohio
WPS: Michigan, Wisconsin, Illinois
What the Medicare LCD on Peripheral Nerve Blocks and Procedures for Chronic Pain Proposes
This proposal represents a significant rollback of access to evidence-based pain management therapies and threatens patients’ ability to receive treatments that help restore mobility, reduce opioid reliance, and improve quality of life. The proposed LCDs provide coverage only for radio frequency neurolysis for trigeminal neuralgia, corticosteroid injections for median neuropathy at the wrist (limited to a maximum of three injections), and corticosteroid injections for Morton’s neuroma (limited to a maximum of two injections).
All other peripheral nerve block and related procedures are not covered under these policies.
- Occipital nerve block and denervation
- Stellate ganglion block
- Trigeminal nerve block
- Suprascapular nerve block
- Thoracic nerve block
- Thoracic nerve denervation
- Genicular nerve blocks (GNB), cryoneurolysis or ablation
- Pudendal nerve block
- Digital nerve block
- Posterior tibial nerve block at the tarsal tunnel
- Ulnar nerve block
- Denervation of the trigeminal nerve for any diagnosis other than TN
- Any other peripheral nerve blocks, or denervation not listed above
Exceptions:
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Regional anesthetic blocks
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Acute surgical pain management
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Pain related to malignancy refractory to medical management
AAPM’s Response Plan to the Proposed LCD
Peripheral nerve blocks have decades of clinical use, robust safety data, and documented benefits for functional restoration and opioid reduction. Restricting access jeopardizes patient outcomes and undermines multidisciplinary pain care.
AAPM Will:
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Submit a formal comment letter to CMS.
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Sign on to the Multisociety Pain Workgroup letter.
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Share its official letter with members to support aligned advocacy.
How to Submit Comments on the Medicare Peripheral Nerve Block Draft LCD
Clinicians and stakeholders are encouraged to submit public comments directly to their respective MACs. Public comments are open until November 8 for CGS, NGS, Noridian, and Palmetto, and until November 22 for WPS.
AAPM will stay in touch with our members and provide a copy of the AAPM letter. When you receive AAPM’s official letter comment, you may use it as a reference to develop your own letter. However, if you’d like to craft your own letter before then, please do so.
Comments may be submitted directly through each Medicare Administrative Contractor (MAC) by using the links provided below:
NGS (DL40267):
Open Comment Period: closes 11/8
Noridian (DL40265):
Open Comment Period: closes 11/8
Palmetto (DL40263):
Open Comment Period: closes 11/8
CGS (DL40261):
Open Comment Period: closes 11/8
WPS (DL40300):
Open Comment Period: closes 11/22