CMM-209: Regional Sympathetic Blocks

Regional sympathetic blocks (stellate or lumbar) are medically necessary as an initial diagnostic test only when strict CRPS diagnostic criteria are met and the procedure is performed under fluoroscopic guidance; up to three additional diagnostic blocks within two weeks of a positive initial block and up to six therapeutic blocks (no more than one per week, and no more than ten sympathetic blocks in 12 months) are allowed, while blocks without fluoroscopy, without documented benefit, or without participation in active rehabilitation are not medically necessary. Key requirements include documentation of CRPS criteria (disproportionate pain, ≥1 reported symptom and ≥1 sign in two or more categories), a positive diagnostic response (≥50% pain reduction and improved function for the duration of the anesthetic) to justify further blocks, evidence of decreased medication use/increased function/increased tolerance to touch for therapeutic repeats, fluoroscopic use documentation, and tracking of prior block counts.