Percutaneous Image-Guided Nerve Cryoablation for Phantom Limb Pain (PLP)

This policy addresses percutaneous image‑guided (CT or ultrasound) nerve cryoablation/cryoneurolysis for phantom limb pain (PLP), including targeting peripheral nerves and neuromas in the residual limb and post–lower‑extremity amputation pain. However, the procedure is considered experimental/investigational and not covered because evidence is limited to small, short‑term studies (follow‑up to ~45 days), with uncertain optimal parameters, unestablished long‑term safety and efficacy, and a small randomized trial showing no benefit at 4 months.

"Phantom limb pain (PLP) management, including pharmacologic therapies (analgesics, anticonvulsants) and non‑pharmacologic therapies (nerve blocks, electrical stimulation, psychological counseling, ..."

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