CMM-209: Regional Sympathetic Blocks

Regional sympathetic (stellate and lumbar) blocks are covered for diagnosing and treating sympathetically mediated CRPS of the extremities (not for head/face/neck, trunk, perineum/pelvis, or abdominal viscera); radiofrequency ablation, chemical neurolysis, and injectates other than anesthetic, corticosteroid, or contrast are considered experimental/not covered. Key requirements: meet all CRPS diagnostic criteria with ≥6 months physician‑supervised conservative management, document required symptoms and signs, use image guidance (fluoroscopy or ultrasound for stellate; fluoroscopy only for lumbar), define a positive diagnostic block as ≥50% pain reduction for the anesthetic duration (initial diagnostic block ± up to 3 additional diagnostic blocks within 2 weeks), limit therapy to ≤1/week and ≤6 therapeutic blocks (≤4 diagnostic; ≤10 total in 12 months), require participation in an active rehabilitation program and documented functional improvement and reduced medication use for repeat therapeutic blocks.