Peripheral Nerve Blocks and Procedures for Chronic Pain

Radiofrequency neurolysis is covered for trigeminal neuralgia only when the condition has persisted ≥6 months, medical therapy has failed or been intolerable, the patient declines or is not a surgical candidate, and diagnostic trigeminal nerve block produced ≥75% improvement; RF treatments are limited to 2 within a rolling 12 months. Corticosteroid injections are covered for carpal tunnel syndrome (maximum 3 lifetime per side) and Morton's neuroma (maximum 2 lifetime per side); local-anesthetic-only PNBs and denervation for CTS are not covered. Multiple exclusions apply (including many peripheral nerve denervations and investigational uses such as treatment of CRPS or widespread pain), biologic injectates are excluded, and specific documentation requirements apply for diagnostic block results, medication failures, device-related procedures, and any exceptional use of deeper sedation.

"Radiofrequency neurolysis (RFN) is covered for trigeminal neuralgia when the condition has been present for at least 6 months."