CMM-209: Regional Sympathetic Blocks

Covered: diagnostic stellate and lumbar sympathetic blocks to establish sympathetically mediated CRPS (initial block must yield ≥50% pain reduction and functional improvement for the anesthetic duration), with up to three additional blocks within two weeks to obtain a therapeutic response. Key requirements/exclusions: further therapeutic blocks (≤6 total, ≤1/week) are covered only with fluoroscopic guidance as part of a documented comprehensive pain program showing decreased medication use, increased function and tolerance to touch, ongoing active rehabilitation, and CRPS documented per IASP/Budapest; blocks without fluoroscopy, without rehab participation, without demonstrable benefit, or for other autonomic nerves are excluded.

"Procedure coding information (CPT codes available for informational purposes: 64510 for stellate ganglion; 64520 for lumbar or thoracic paravertebral sympathetic) and supporting claim documentation."