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

Peripheral nerve blocks with local anesthetic ± corticosteroid and denervation procedures are covered for chronic pain per LCD DL40300, with therapeutic radiofrequency neurolysis covered only for refractory trigeminal neuralgia. Coverage excludes systemic peripheral neuropathy, generalized chronic pain, and most neuropathic pain (except trigeminal neuralgia and carpal tunnel); limits include one diagnostic block per peripheral nerve, lifetime per-side caps for steroid injections for Morton’s neuroma and carpal tunnel, and a two-procedure per 12-month limit for therapeutic radiofrequency neurolysis. Documentation must be legible, signed, support ICD-10/CPT selection, include procedural indications and medical necessity, and diagnostic blocks must record pre/post standardized pain scores; use ABN/modifiers per Medicare guidance when non-coverage is anticipated.

"Peripheral nerve blocks consisting of local anesthesia with or without corticosteroids and denervation procedures are covered when performed for chronic pain per the LCD DL40300 reasonable and nece..."