Laser Neurolysis

Aetna considers laser peripheral nerve block (laser neurolysis) experimental/investigational and does not cover it for any indications — specifically excluded for carpal tunnel syndrome, complex regional pain syndrome, facet joint pain, phantom limb pain, and sacroiliac joint pain (includes ICD-10 codes such as G54.6, G56.00–G56.03, G56.40–G56.42). There are no covered/medically necessary indications or special authorization requirements listed, as the exclusion is based on insufficient evidence of effectiveness.

"ICD-10 codes not covered for indications listed in the CPB (not all-inclusive): M54."

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