CMM-209: Regional Sympathetic Blocks

Cigna covers initial diagnostic stellate or lumbar regional sympathetic blocks, up to three additional diagnostic blocks within 2 weeks after a positive block, and up to six therapeutic blocks (maximum 10 total in 12 months) for extremity CRPS, while radiofrequency ablation, chemical neurolysis, blocks for non‑extremity CRPS, and procedures not meeting criteria are not covered. Coverage requires meeting specified CRPS diagnostic criteria with documented signs/symptoms limited to the extremities, a positive diagnostic response (≥50% pain reduction and functional improvement for the anesthetic duration), use only of anesthetic/corticosteroid/contrast with required image guidance (stellate: fluoroscopy or ultrasound; lumbar: fluoroscopy), therapeutic blocks no more than once weekly, and participation in an active rehabilitation/functional restoration program with documentation of functional improvement and reduced medication use.

"The performance of an initial diagnostic regional sympathetic block is considered medically necessary to establish the presence or absence of sympathetically mediated complex regional pain syndrome..."