Peripheral Nerve Blocks and Procedures for Chronic Pain

Radiofrequency neurolysis is covered for trigeminal neuralgia only after ≥6 months duration, failure or intolerance of appropriate medical therapy, patient refusal or unsuitability for surgery, and a diagnostic trigeminal nerve block showing ≥75% improvement; RFTs are limited to 2 in any rolling 12 months. Corticosteroid injections (with or without local anesthetic) are covered for carpal tunnel syndrome (maximum 3 lifetime injections per side) and Morton's neuroma (maximum 2 lifetime injections per side); PNBs using only local anesthetic for CTS and various denervation procedures for many named nerves are non-covered or investigational. Documentation requirements include evidence of diagnostic block response and prior medical therapy for trigeminal neuralgia, justification for any atypical sedation, and medical necessity documentation when multiple procedures are performed same-day or in patients with implanted devices.

"Radiofrequency neurolysis (RFN) is medically reasonable and necessary for trigeminal neuralgia when all of the following are met: condition duration ≥ 6 months; non-responsive or intolerant to medi..."