CMM-209: Regional Sympathetic Blocks

Initial diagnostic regional sympathetic blocks (stellate or lumbar) are covered to establish sympathetically mediated CRPS if performed under fluoroscopic guidance and produce ≥50% pain reduction with improved function for the duration of the local anesthetic; up to three additional blocks within two weeks may be allowed and therapeutic blocks (maximum six total, no more than once weekly) are covered only as part of a comprehensive pain-management program with documented decreased analgesic use, improved function, increased tolerance to touch, and ongoing active rehabilitation. Blocks are excluded if not fluoroscopically guided, if the diagnostic block fails to show the required ≥50% pain reduction/improved function, if the patient cannot or will not participate in active rehabilitation, or if repeat therapeutic blocks lack documented clinical benefit; documentation must include CRPS per IASP/Budapest criteria, procedure technique, timing, and outcome measures.