Local Coverage Determination (LCD)

Nerve Blocks for Peripheral Neuropathy

L35222

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Proposed LCD
Proposed LCDs are works in progress that are available on the Medicare Coverage Database site for public review. Proposed LCDs are not necessarily a reflection of the current policies or practices of the contractor.

Document Note

Note History

Contractor Information

LCD Information

Document Information

Source LCD ID
N/A
LCD ID
L35222
Original ICD-9 LCD ID
Not Applicable
LCD Title
Nerve Blocks for Peripheral Neuropathy
Proposed LCD in Comment Period
N/A
Source Proposed LCD
N/A
Original Effective Date
For services performed on or after 10/01/2015
Revision Effective Date
For services performed on or after 11/30/2023
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
N/A
Notice Period End Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

Issue

Issue Description

Biannual review was completed with no change in coverage.

Issue - Explanation of Change Between Proposed LCD and Final LCD

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1862(a)(1)(A) This section allowed coverage and payment for only those services that are considered to be medically reasonable and necessary.

Title XVIII of the Social Security Act, §1833(e) The section prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Title XVIII of the Social Security Act, §1862 (a) (7). This section excludes routine physical examinations and services.

CMS Pub 100-03 Medicare National Coverage Determinations (NCD) Manual Chapter - 1 Sections:
30.3 – Acupuncture
150.7 - Prolotherapy, Joint Sclerotherapy, and Ligamentous Injections with Sclerosing Agents
150.6 -Vitamin B12 Injections to Strengthen Tendons, Ligaments, etc., of the Foot

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Nerve blocks cause the temporary interruption of conduction of impulses in peripheral nerves or nerve trunks by the injection of local anesthetic agent(s) and/or steroid.

The use of nerve blocks or injections for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases is not considered medically necessary. Medical management using systemic medications is clinically indicated for the treatment of these conditions.

Limitations

The use of nerve blocks with or without the use of electrostimulation, and the use of electrostimulation alone for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases is not considered medically reasonable and necessary.

At present, the literature and scientific evidence supporting the use of peripheral nerve blocks with or without the use of electrostimulation/electromagnetic stimulation, and the use of electrostimulation/ electromagnetic stimulation alone for neuropathies or peripheral neuropathies caused by underlying systemic diseases, is insufficient to warrant coverage. These procedures are considered investigational and are not eligible for coverage for the treatment of neuropathies or peripheral neuropathies caused by underlying systemic diseases.

The use of ultrasound guidance in conjunction with these non -covered injections is also considered not medically necessary and will result in denial.

Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination)

N/A

Proposed Process Information

Synopsis of Changes
Changes Fields Changed
N/A
Associated Information
Sources of Information
Bibliography
Open Meetings
Meeting Date Meeting States Meeting Information
N/A
Contractor Advisory Committee (CAC) Meetings
Meeting Date Meeting States Meeting Information
N/A
MAC Meeting Information URLs
N/A
Proposed LCD Posting Date
Comment Period Start Date
Comment Period End Date
Reason for Proposed LCD
Requestor Information
This request was MAC initiated.
Requestor Name Requestor Letter
N/A
Contact for Comments on Proposed LCD

Coding Information

Bill Type Codes

Code Description
N/A

Revenue Codes

Code Description
N/A

CPT/HCPCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

Group 1 Paragraph:

N/A

Group 1 Codes:

N/A

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph:

N/A

Group 1 Codes:

N/A

N/A

Additional ICD-10 Information

General Information

Associated Information

Utilization Guidelines
Treatment protocols utilizing multiple injections per day on multiple days per week for the treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases are not considered medically necessary.

Sources of Information
N/A
Bibliography

Bril, V., England, J. (2011). Evidence-Based Guideline: Treatment of Painful Diabetic Neuropathy. Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology, 76(20), 1758-65. NGC: 008504.

Cernak, C., Marriot, E., et al. (2012). Electrical current and local anesthetic combination successfully treats pain associated with diabetic neuropathy. Practical Pain Management, 12(3), 23-36.

Chaudhry, V., Stevens, J.C., et al. (2006). Practice advisory: utility of surgical decompression for treatment of diabetic neuropathy: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology, 2, 1805-1808.

Hamza, M.A., White, P.F., Craig, W.F., et al. (2000). Percutaneous electrical nerve stimulation: A novel analgesic therapy for diabetic neuropathic pain. Diabetes Care, 23(3), 365-370.

Odell, R.H., Sorgnard, R. (2011). New technique combines electrical and local anesthetic for pain management. Practical Pain Management, 11(5), 52-68.

Revision History Information

Revision History Date Revision History Number Revision History Explanation Reasons for Change
11/30/2023 R10

Posted 11/30/2023 Review completed 10/19/2023. Under CMS National Coverage Policy updated section heading for regulations.

  • Other (Review)
12/30/2021 R9

12/30/2021 Review completed 10/26/2021. Moved sources of information to bibliography. Under CMS National Coverage Policy updated section headings for regulations.

  • Other (Review)
07/30/2020 R8

07/30/2020 In Coverage Indications, Limitations, and/or Medical Necessity: To be consistent with description change of 64450 in 2020 CPT Codebook deleted “solutions” and added “agent(s) and/or steroid”. Documentation Requirements removed due to redundancy since located in A57589 - Billing and Coding: Nerve Blocks for Peripheral Neuropathy. Reformatted Utilization Guidelines by removing the sentence related to the redetermination process.

  • Provider Education/Guidance
  • Other
11/01/2019 R7

11/01/2019 Change Request 10901 Local Coverage Determinations (LCDs): it will no longer be appropriate to include Current Procedure Terminology (CPT)/Health Care Procedure Coding System (HCPCS) codes or International Classification of Diseases Tenth Revision-Clinical Modification (ICD-10-CM) codes in the LCDs. All CPT/HCPCS, ICD-10 codes, and Billing and Coding Guidelines have been removed from this LCD and placed in the Billing and Coding Article related to this LCD. Consistent with Change Request 10901, if any language from IOMs and/or regulations was present in the LCD, it has been removed and the applicable manual/regulation has been referenced. Review completed.

  • Other (Changes in response to CMS Change Request 10901. Review completed. )
01/01/2019 R6

01/01/2019 Annual review done 12/04/2018 with no change in coverage. Punctuation errors corrected.

  • Other ((Annual) )
04/01/2018 R5

04/01/2018 Annual review done 03/06/2018 with no change in coverage. Punctuation error corrected.

  • Other ((Annual) )
01/01/2018 R4

 

01/01/2018 CPT/HCPCS code updates; description changes for Group 2 codes 76881 and 76882. At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

 

  • Revisions Due To CPT/HCPCS Code Changes
05/01/2017 R3 05/01/2017 Annual review done 03/31/2017 no change in coverage.
  • Other ((Annual review))
10/01/2015 R2 05/01/2016 Annual review no change to coverage. Removed CAC information.
  • Other (Annual review)
10/01/2015 R1 05/01/2015 Annual review no change to coverage.
  • Other (Annual review)
N/A

Associated Documents

Attachments
N/A
Public Versions
Updated On Effective Dates Status
11/20/2023 11/30/2023 - N/A Currently in Effect You are here
12/20/2021 12/30/2021 - 11/29/2023 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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