Billing and Coding: Peripheral Nerve Blocks and Procedures for Chronic Pain

Peripheral nerve blocks (local anesthetic ± corticosteroid) and denervation procedures are covered for chronic non-cancer pain when meeting the reasonable and necessary requirements of LCD DL40261; therapeutic radiofrequency neurolysis is covered only for refractory trigeminal neuralgia. Coverage excludes cancer-related pain, spasticity treatments, systemic peripheral neuropathy, generalized neuropathic pain, dry needling, and use of non–FDA-approved injectants; specific frequency limits apply (e.g., one diagnostic block per peripheral nerve, Morton's neuroma steroid injections ≤2 lifetime per side, CTS steroid injections ≤3 lifetime per side, and radiofrequency neurolysis ≤2 per rolling 12 months). Documentation must be legible and support ICD-10 and CPT coding, include procedural indications and pre/post pain scores for diagnostic blocks, and follow NCCI/OPPS/CPT coding and ABN modifier guidance.

"Peripheral nerve blocks (local anesthesia with or without corticosteroids) and denervation procedures are covered for chronic pain when they meet the reasonable and necessary requirements in LCD DL..."