CMM-402: Greater Occipital Nerve Block

GONB is covered only for treatment of occipital neuralgia and excludes occipital nerve ablation and use of injectates other than local anesthetic and/or steroid. Coverage requires a documented comprehensive headache evaluation excluding other causes, diagnostic evidence of paroxysmal stabbing pain in the greater occipital nerve distribution with tenderness, documented clinically meaningful improvement for repeat injections, combination with a self-care program, limits of up to six injections per 12 months (with ≥4 weeks between certain cervical procedures and only one invasive spinal procedure per date of service), and co-management/plan for opioid risk if the patient has been on continuous opioids ≥3 months.

"Use of greater occipital nerve block (GONB) to treat occipital neuralgia (guideline only applies to GONB used to treat occipital neuralgia)."

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