Local Coverage Determination (LCD)

Nerve Blocks and Electrostimulation for Peripheral Neuropathy

L37642

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Contractor Information

LCD Information

Document Information

LCD ID
L37642
LCD Title
Nerve Blocks and Electrostimulation for Peripheral Neuropathy
Proposed LCD in Comment Period
N/A
Source Proposed LCD
N/A
Original Effective Date
For services performed on or after 01/29/2018
Revision Effective Date
For services performed on or after 07/29/2021
Revision Ending Date
N/A
Retirement Date
N/A
Notice Period Start Date
12/14/2017
Notice Period End Date
01/28/2018
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2022 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.

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Copyright © 2022, 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.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, §1862(a)(1)(D) and (E) Items and services related to research and experimentation

Title XVIII of the Social Security Act, §1862(a)(7) states Medicare will not cover any services or procedures associated with routine physical examinations.

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 1, §30.3 Acupuncture

CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 2, §150.6 Vitamin B12 Injections to Strengthen Tendons, Ligaments, etc., of the Foot and §150.7 Prolotherapy, Joint Sclerotherapy, and Ligamentous Injections with Sclerosing Agents

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

Background

Nerve blocks, injections of local anesthetic solutions, cause the temporary interruption of conduction of impulses in peripheral nerves or nerve trunks.

There are also early studies using electrostimulation with or without nerve blocks for treatment of multiple neuropathies or peripheral neuropathies caused by underlying systemic diseases.

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. Medical management using systemic medications is clinically indicated for the treatment of these conditions.

At present, the literature and scientific evidence supporting the use of peripheral nerve blocks with or without the use of electrostimulation, and the use of electrostimulation 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.

Summary of Evidence

N/A

Analysis of Evidence (Rationale for Determination) N/A

General Information

Associated Information
N/A
Sources of Information

N/A

Bibliography

Bril V, England J, et al. Evidence-based guideline: Treatment of painful diabetic neuropathy. Neurology. 2011;76(20):1758-65.

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

Chaudhry V, Stevens JC, et al. Practice advisory: Utility of surgical decompression for treatment of diabetic neuropathy. Neurology. 2006;66(12):1805-1808.

Hamza MA, White PF, et al. Percutaneous electrical nerve stimulation: A novel analgesic therapy for diabetic neuropathic pain. Diabetes Care. 2000;23(3):365-370.

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

Revision History Information

Revision History DateRevision History NumberRevision History ExplanationReasons for Change
07/29/2021 R5

Under CMS National Coverage Policy updated section headings and descriptions to regulations. Under Bibliography changes were made to citations to reflect AMA citation guidelines. Formatting was corrected throughout the LCD.

  • Provider Education/Guidance
10/10/2019 R4

This LCD is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs. There has been no change in coverage with this LCD revision. Title XVIII of the Social Security Act, §1833(e) was removed from the CMS National Coverage Policy section of this LCD and placed in the related Billing and Coding: Nerve Blocks and Electrostimulation for Peripheral Neuropathy A56731 article.

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.

  • Provider Education/Guidance
07/25/2019 R3

All coding located in the Coding Information section and all verbiage regarding billing and coding under the Associated Information section has been removed and is included in the related Billing and Coding: Nerve Blocks and Electrostimulation for Peripheral Neuropathy A56731 article.

Under Bibliography changes were made to citations to reflect AMA citation guidelines.

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.

  • Provider Education/Guidance
02/26/2018 R2 The Jurisdiction "J" Part B Contracts for Alabama (10112), Georgia (10212) and Tennessee (10312) are now being serviced by Palmetto GBA. The notice period for this LCD begins on 12/14/17 and ends on 02/25/18. Effective 02/26/18, these three contract numbers are being added to this LCD. No coverage, coding or other substantive changes (beyond the addition of the 3 Part B contract numbers) have been completed in this revision.
  • Change in Affiliated Contract Numbers
01/29/2018 R1

The Jurisdiction "J" Part A Contracts for Alabama (10111), Georgia (10211) and Tennessee (10311) are now being serviced by Palmetto GBA. The notice period for this LCD begins on 12/14/17 and ends on 01/28/18. Effective 01/29/18, these three contract numbers are being added to this LCD. No coverage, coding or other substantive changes (beyond the addition of the 3 Part A contract numbers) have been completed in this revision.

  • Other

Associated Documents

Attachments
N/A
Related National Coverage Documents
N/A
Public Versions
Updated On Effective Dates Status
07/23/2021 07/29/2021 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

  • Surgery: Nerve Blocks and Electrostimulation for Peripheral Neuropathy

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