URL for source document:

https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=35457&ver=58&bc=0
LCD Title
Nerve Blockade for Treatment of Chronic Pain and Neuropathy

AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2021 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 © 2021 American Dental Association. All rights reserved.

Copyright © 2013 - 2022, the American Hospital Association, Chicago, Illinois. Reproduced by CMS 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. To
license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. You
may also contact us at [email protected].

Issue

Issue Description

Need to remove coverage for cervical and thoracic epidural blocks as it will be addressed in the
Multi-Jurisdictional MACs policy Epidural Steroid Injections for Pain Management LCD and the associated
Billing and Coding Epidural Steroid Injections for Pain Management LCA effective 6/19/2022.

Issue - Explanation of Change Between Proposed LCD and Final LCD

No Comments received within the specified Comment Period. No changes made to this Final LCD from the
Proposed LCD.

CMS National Coverage Policy

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

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

Title XVIII of the Social Security Act, section 1862 (a)(7) excludes routine physical evaluations.

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

Coverage Guidance

Coverage Indications, Limitations, and/or Medical Necessity

For the purposes of this LCD and consistent with standard community understanding and the
recommendations of specialty societies, pain is defined as an unpleasant sensory and emotional experience
associated with actual or potential tissue damage. Pain is chronic when it has been present, continuously or
intermittently, despite therapy for three months or more.

Nerve blocks cause the temporary interruption of conduction of impulses in peripheral nerves or nerve trunks
by the injection of local anesthetic solutions. Their utility in the diagnosis and treatment of non-neuropathic
pain and specific syndromes mediated by sympathetic nervous system overactivity has been established.

Diagnostic - to determine the source of pain e.g., to identify or pinpoint a nerve that acts as a pathway for
pain; to determine the type of nerve that conducts the pain; to distinguish between pain that is central (within
the brain and spinal cord) or peripheral (outside the brain and spinal cord) in origin; or to determine whether a
neurolytic block or surgical lysis of the nerve should be performed. The type of diagnostic test may include
injecting saline to stimulate pain or injecting an anesthetic agent to evaluate the patient's response, as an initial
diagnostic step so that other pain relief options may be considered.

Therapeutic - to treat painful conditions that respond to nerve blocks (e.g., celiac block for pain of
pancreatic cancer) and /or inappropriate sympathetic nervous system activity. An appropriate injection of
local anesthetic induces a temporary interruption in the conduction of impulses by peripheral nerves or nerve
trunks. Longer-lasting or permanent blockade may be induced with the injection of neurolytic agents and/or
application of thermal (not pulsed) radiofrequency. When blockade has been of value in the relief of acute or
chronic cancer related pain, somatic or epidural blockade may be maintained through the infusion of local
anesthetics via indwelling catheter.

Prior to blockade, all patients with pain complaints require an evaluation that includes, at a minimum, an
assessment of the source of the pain and treatment of any underlying pathology. Evaluation must be
documented in the patient s records. In addition, those patients who do not respond to injections or otherwise
continue with persistent or poorly responsive pain should be referred for a multi-disciplinary or other
collaborative comprehensive evaluation.

Imaging guidance with fluoroscopy, CT or ultrasound may be necessary to perform somatic nerve blockade.
Only fluoroscopic or CT guidance may be covered for epidural injections. It is inappropriate to bill for
fluoroscopy (CPT® codes 77002 or 77003) with a 59 modifier when the procedure(s) billed on that date of

2
service for the same patient by the same provider are included in the CPT® description of the procedure(s)
performed.

Provider Qualifications

The CMS Manual System, Pub. 100-8, Program Integrity Manual, Chapter 13, Section 5.1
(http://www.cms.hhs.gov/manuals/downloads/pim83c13.pdf) states that "reasonable and necessary" services
are "ordered and/or furnished by qualified personnel." Services will be considered medically reasonable and
necessary only if performed by appropriately trained providers.

Patient safety and quality of care mandate that healthcare professionals who perform Nerve Blocks are
appropriately trained and/or credentialed by a formal residency/fellowship program and/or are certified by
either an accredited and nationally recognized organization or by a post-graduate training course accredited by
an established national accrediting body or accredited professional training program. If the practitioner works
in a hospital facility at any time and/or is credentialed by a hospital for any procedure, the practitioner must be
credentialed to perform the same procedure in the outpatient setting. At a minimum, training must cover and
develop an understanding of anatomy and drug pharmacodynamics and kinetics as well as proficiency in
diagnosis and management of disease, the technical performance of the procedure and utilization of the
required associated imaging modalities.

PERIPHERAL NEUROPATHY

Nerve blockade and/or electrical stimulation are non-covered for the treatment of metabolic peripheral
neuropathy. The peer-reviewed medical literature has not demonstrated the efficacy or clinical utility of nerve
blockade or electrical stimulation, alone or used together, in the diagnosis and/or treatment of neuropathic
pain.
The use of imaging guidance (i.e. ultrasound, CT, or fluoroscopic guidance) in conjunction with these
non-covered injections is also considered not medically necessary.
The use of electrostimulation alone for the treatment of multiple neuropathies or peripheral neuropathies
caused by underlying systemic diseases is not medically reasonable and necessary. These procedures are
considered investigational. Medical management using systemic medications is clinically indicated for the
treatment of these conditions.

SOMATIC NERVE BLOCK

Radiculopathy and other neurological deficits require further evaluation and management prior to
performing the blocks.

EPIDURAL BLOCK (Cervical and Thoracic)

This policy does not cover epidural blocks, which are covered in another Noridian policy. Please refer to
L39242/A58995.

Summary of Evidence

NA

Analysis of Evidence (Rationale for Determination)

NA

3
General Information

Associated Information

General Information

Please refer to LCD 34076 for coverage criteria for Injections - Tendon, Ligament, Ganglion Cyst, Tunnel
Syndromes and Morton's Neuroma. Access this LCD under Related Local Coverage Documents below.

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.

A peripheral nerve injection may be allowed during the reconsideration process if the medical record supports
a medically necessary service.

Sources of Information

1. Bril V, England J. 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. 2011: May 17;
76(20):1758-65. NGC: 008504.

2. Cernak C, Marriot E, et al. Electrical current and local anesthetic combination successfully treats pain
associated with diabetic neuropathy: Practical Pain Management; April 2012 online at:
http://www.practicalpainmanagement.com/issue/1203

3. Chaudhry V, Stevens JC, et al. 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. 2006;2:1805-1808.

4. Hamza MA, White PF, Craig WF, et al. Percutaneous Electrical Nerve Stimulation: A Novel Analgesic
Therapy for Diabetic Neuropathic Pain. Diabetes Care. 2000: March; 23(3):365-370.

5. Joint section on pain, the American Association of Neurological Surgeons and Congress of Neurological
Surgeons.

6. Karmakar MK et al. Thoracic paravertebral block for management of pain associated with multiple
fractured ribs in patients with concomitant lumbar spinal trauma. Reg Anesth Pain Med 2001; 26:169-173

7. Merskey H, Bogduk N. Description of chronic pain syndromes and definitions of pain terms.
In: Classification of Chronic Pain, 2nd ed. Seattle, WA: IASP press; 1994.

8. Naja MZ et al. Nerve-stimulator guided paravertebral blockade vs. general anesthesia for breast
surgery. Euro J. Anaesth. 2003;20:897-903.

9. Noridian Intermediary Advisory Committee (IAC) on Pain

4
10. Odell RH, Sorgnard R, New technique combines electrical and local anesthetic for pain
management: Practical Pain Management; June 2011: online at
http://www.practicalpainmanagement.com>/issue/1106

11. Yale University School of Medicine, Department of Pain Management

Bibliography

NA

Revision History Information

Revision Revision
History History
Date Number Revision History Explanation Reasons for Change
09/04/2022R18 No Comments received within the specified
Comment Period. No changes made to this • Other (No Comments received
Final LCD from the Proposed LCD. within the specified Comment
Period. No changes made to this
Final LCD from the Proposed
LCD.)
02/03/2022R17 Under General Information removed the
broken link to LCD 34076 - Injections - • Typographical Error
Tendon, Ligament, Ganglion Cyst, Tunnel
Syndromes and Morton's Neuroma and added
the sentence Access this LCD under Related
Local Coverage Documents below.

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.
12/01/2019R16 The LCD is revised to remove CPT/HCPCS
codes in the Keyword Section of the LCD. • Other (The LCD is revised to
remove CPT/HCPCS codes in
At this time 21st Century Cures Act will apply the Keyword Section of the LCD.
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.
12/01/2019R15 As required by CR 10901, all billing and
coding information has been moved to the • Revisions Due To Code Removal
companion article; this article is linked to the
LCD.

5
 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.
01/01/2019R14 The LCD revised to remove deleted CPT code
64508 in Group 1 effective 1/1/2019. • Revisions Due To CPT/HCPCS
Code Changes
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 in the LCD are applicable as noted in
this policy.

10/01/2017R13 6/25/18-At this time 21st Century Cures Act

will apply to new and revised LCD's that • Other (Approve Annual Review
restrict coverage which requires comment and Date to relate LCD to a LCA.)
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.

No change in coverage made for this LCD.

Approved addition of Annual Review Date to
relate LCD to Local Coverage Article
A56034 Peripheral Nerve Blocks Non-covered
for the Treatment of Diabetic Peripheral
Neuropathic Pain.
10/01/2017R12 02/12/2018-At this time 21st Century Cures
Act will apply to new and revised LCD's that • Provider Education/Guidance
restrict coverage which requires comment and • Creation of Uniform LCDs
notice. This revision is not a restriction to the Within a MAC Jurisdiction
coverage determination; and, therefore not all
the fields included on the LCD are applicable
as noted in this policy.

Removed 64455 & 64632 with DX codes

G56.01-G56.03, G57.51-G57.53 and
G57.61-G57.63 as coverage criteria is
explained in LCD L34076. Removed duplicate
diagnosis codes from the ICD-10 Codes that
DO NOT Support Medical Necessity section
which are listed in the Group 1 Asterisk
section and noted as non-covered when billed
with Group 2 CPT codes.
10/01/2017R11

6
 01/16/18-At this time 21st Century Cures Act • Provider Education/Guidance
will apply to new and revised LCD's that • Creation of Uniform LCDs
restrict coverage which requires comment and Within a MAC Jurisdiction
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.

Clarified it is inappropriate to bill for

fluoroscopy (CPT® codes 77002 or 77003)
with a 59 modifier when the procedure(s)
billed on that date of service for the same
patient by the same provider are included in
the CPT® description of the procedure(s)
performed under Coverage Indications,
Limitations and/or Medical Necessity
10/01/2017R10 08/24/2017: At this time 21st Century Cures
Act will apply to new and revised LCDs that • Revisions Due To ICD-10-CM
restrict coverage which requires comment and Code Changes
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.

Effective DOS 10/01/2017 the following

ICD-10-CM codes were added or deleted:

Added:

• M48.062

The following ICD-10 codes were deleted

from the ICD-10 Codes that Support Medical
Necessity field:
M48.06 was deleted from Group 1
01/01/2017R9 LCD revised to add CPT codes 62320, 62321,
62324 and 62325 to Group 1 effective • Creation of Uniform LCDs
01/01/2017. No change in coverage has been Within a MAC Jurisdiction
made. • Revisions Due To CPT/HCPCS
Code Changes
CPT codes 62310 and 62318 were are deleted
from Group 1 effective 12/31/2016
11/10/2016R8 This final LCD, effective 11/10/2016,
combines JFA L35458 into the JFB L35457 • Creation of Uniform LCDs
LCD so that both JFA and JFB contractor Within a MAC Jurisdiction
numbers will have the same final MCD LCD
number L35457. Coverage will remain the
same as the coverage effective 10/01/2016.
10/01/2016R7 The LCD is revised to add the new ICD-10
codes effective 10/1/2016: G56.03, G56.13, • Revisions Due To ICD-10-CM
G56.23, G56.33, G56.43, G56.92, G57.03, Code Changes

7
 G57.13, G57.23, G57.33, G57.43, G57.53,
G57.63*, G57.73, M50.121, M50.122,
M50.123, M50.221, M50.222, M50.223,
M50.321, M50.322 and M50.323.

The following ICD-10 codes were deleted

from Group 1 effective 10/1/2016: M50.12,
M50.22, M50.32.

The following ICD-10 code descriptions were

changed effective 10/1/2016 in Group 1:
S54.8X1A, S54.8X1D, S54.8X1S, S54.8X2A,
S54.8X2D, S54.8X2S.
01/01/2016R6 R6 LCD revised to add ICD-10-CM codes
R10.11-R10-13, R10.31-R10.33 & asterisks to • Creation of Uniform LCDs
ICD-10-CM codes G57.91-G57.92 in the Within a MAC Jurisdiction
Group 1 ICD-10 codes that Support Medical
Necessity. Add G57.91-G57.92 codes to the
Group 1: Medical Necessity ICD-10 codes
Asterisk Explanation, added G57.91-G57.92 to
the Group 1 Paragraph & list of Codes in the
ICD-10-CM Codes that DO NOT Support
Medical Necessity section. Also added the
following statements: CPT codes 64450 or
64640 may not be billed with diagnosis G57.61
and G57.62. The correct CPT procedure codes
are 64455 or 64632 when billing for the
diagnosis of Morton s Neuroma to Group 1
Paragraph in the CPT/HCPCS Code Section;
and G57.61, G57.62 - The correct CPT
procedure codes are 64455 or 64632 when
billing for the diagnosis of Morton s
Neuroma. CPT codes 64450 or 64640 may not
be billed with diagnosis G57.61, G57.62 to the
Group1: Medical Necessity ICD-10 Codes
Asterisk Explanation.
01/01/2016R5 R5 - Clarified when duplicated ICD-10-CM
codes G58.7, G58.8, G58.9 G59, M54.10 and • Other (Clarification of when
M79.2 are allowed and denied in Group 2 duplicated ICD-10 codes are
Paragraph, Group 1 Medical Necessity ICD-10 allowed and denied when billed
Codes Asterisk Explanation and Group 1 with 64450.)
Paragraph in the ICD-10 Codes that DO NOT
Support Medical Necessity
01/01/2016R4 R4 LCD revised to add CPT codes
64461-64463 to Group 1 of the CPT/HCPCS • Revisions Due To CPT/HCPCS
Codes section and the following CPT/HCPCS Code Changes
codes were deleted: 64412 was deleted from
Group 1 per 2016 CPT/HCPCS update.
10/01/2015R3 LCD revision expands coverage to include
codes with the 7th character extender S for • Other (Expansion of coverage to
S14, S24, S34, S44, S54, S64, S74, S84 and include codes with the 7th

8
 S94 codes that are currently listed in the policy character extender S for S14,
as covered with A & D character S24, S34, S44, S54, S64, S74,
extenders. S84 and S94 codes that are
currently listed in the policy as
covered with A & D
character extenders.)
10/01/2015R2 The LCD is revised to add the sentence "CPT
code 64450 may not be billed with diagnosis • Risk Identified by the Office of
G57.61, G57.62. The correct CPT procedure Inspector General (OIG)
code is 64455 when billing for the diagnosis of
Morton s Neuroma" in the CPT/HCPCS
section and the "Medical Necessity ICD-9
Codes Asterisk Explanation" for Group 1.
10/01/2015R1 This LCD is revised to reflect corrections made
to the ICD-9 version. • Revisions Due To ICD-10-CM
Code Changes
Associated Documents

Attachments
N/A

Related Local Coverage Documents

Articles
A52725 - Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy
A59155 - Response to Comments: Nerve Blockade for Treatment of Chronic Pain and Neuropathy

Related National Coverage Documents

N/A

Public Versions

Updated On Effective Dates Status

07/14/2022 09/04/2022 - N/A Future Effective You are here

URL for source document:

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=52725&ver=25

Article Title
Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy

Article Type
Billing and Coding

9
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2021 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 © 2021 American Dental Association. All rights reserved.

Copyright © 2013 - 2022, the American Hospital Association, Chicago, Illinois. Reproduced by CMS 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. To
license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. You
may also contact us at [email protected].

CMS National Coverage Policy

N/A

Article Guidance

Article Text

The following billing and coding guidance is to be used with its associated Local Coverage Determination.

LCD L35457 states, "Nerve blockade and/or electrical stimulation are non-covered for the treatment of
metabolic peripheral neuropathy. The peer-reviewed medical literature has not demonstrated the efficacy or
clinical utility of nerve blockade or electrical stimulation, alone or used together, in the diagnosis and/or
treatment of neuropathic pain."

The use of peripheral nerve blocks for treating diabetic neuropathy is not considered reasonable and/or
necessary and is not covered by Medicare Part A or B. Such use of peripheral nerve blocks is not supported by
the current peer reviewed, published, evidence based scientific literature nor by specialty society guidelines.
Claims are subject to review and recoupment.

This notification does not affect those regional/local blocks done as part of an operative procedure (for
example wound debridement in the operating room) when performed as an adjunct to or the sole means of

10
regional/local anesthesia for the procedure.

For somatic nerve blocks, it is inappropriate to bill for fluoroscopy (CPT® codes 77002 or 77003) with a 59
modifier when the procedure(s) billed on that date of service for the same patient by the same provider are
included in the CPT® description of the procedure(s) performed.

Documentation Requirements

1. All documentation must be maintained in the patient s medical record and available to the contractor
upon request.
2. Every page of the record must be legible and include appropriate patient identification information
(e.g., complete name, dates of service(s)). The record must include the physician or non-physician
practitioner responsible for and providing the care of the patient.
3. The submitted medical record should support the use of the selected diagnosis code(s). The submitted
CPT/HCPCS code should describe the service performed.

Sources:

1. Neurology 2011;76;1758; V. Bril, J. England, G.M. Franklin, et al. Evidence-based

guideline: Treatment of painful diabetic neuropathy: Report of the American Academy of Neurology,
the American Association of Neuromuscular and Neurodiagnostic Medicine, and the American
Academy of Physical Medicine and Rehabilitation This information is current as of February 7, 2013
2. American Family Physician 2010;82(2):151-158 T. Lindsay, B. Rodgers, V. Savath, K.
Hettinger Treating Diabetic Peripheral Neuropathic Pain

Coding Information

CPT/HCPCS Codes

Expand All | Collapse All

Group 1

(31 Codes)

Group 1 Paragraph

Effective 01/01/2020, 64999 is to be used to report injections of anesthetic and/or steroids for the facial and
phrenic nerves and cervical plexus. This code replaces the deleted codes 64402, 64410 and 64413.

Group 1 Codes

Code Description
62281INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED
SALINE SOLUTIONS), WITH OR WITHOUT OTHER THERAPEUTIC SUBSTANCE;
EPIDURAL, CERVICAL OR THORACIC
62324INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS
INFUSION OR INTERMITTENT BOLUS, OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S)
(EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT
INCLUDING NEUROLYTIC SUBSTANCES, INTERLAMINAR EPIDURAL OR
SUBARACHNOID, CERVICAL OR THORACIC; WITHOUT IMAGING GUIDANCE

11
62325INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS
INFUSION OR INTERMITTENT BOLUS, OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S)
(EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT
INCLUDING NEUROLYTIC SUBSTANCES, INTERLAMINAR EPIDURAL OR
SUBARACHNOID, CERVICAL OR THORACIC; WITH IMAGING GUIDANCE (IE,
FLUOROSCOPY OR CT)
64405INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; GREATER OCCIPITAL NERVE
64408INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; VAGUS NERVE
64415INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; BRACHIAL PLEXUS
64417INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; AXILLARY NERVE
64418INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SUPRASCAPULAR NERVE
64420INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; INTERCOSTAL NERVE, SINGLE
LEVEL
64421INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; INTERCOSTAL NERVE, EACH
ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY
PROCEDURE)
64425INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; ILIOINGUINAL,
ILIOHYPOGASTRIC NERVES
64430INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PUDENDAL NERVE
64435INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; PARACERVICAL (UTERINE)
NERVE
64445INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE
64446INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; SCIATIC NERVE, CONTINUOUS
INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT)
64447INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE
64448INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; FEMORAL NERVE,
CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER PLACEMENT)
64449INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; LUMBAR PLEXUS, POSTERIOR
APPROACH, CONTINUOUS INFUSION BY CATHETER (INCLUDING CATHETER
PLACEMENT)
64450INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE
OR BRANCH
64451INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; NERVES INNERVATING THE
SACROILIAC JOINT, WITH IMAGE GUIDANCE (IE, FLUOROSCOPY OR COMPUTED
TOMOGRAPHY)
64461PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SINGLE INJECTION
SITE (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED)
64462PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SECOND AND ANY
ADDITIONAL INJECTION SITE(S) (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED)
(LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
64463PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; CONTINUOUS
INFUSION BY CATHETER (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED)
64505INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION
64510INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC)
64517INJECTION, ANESTHETIC AGENT; SUPERIOR HYPOGASTRIC PLEXUS
64520INJECTION, ANESTHETIC AGENT; LUMBAR OR THORACIC (PARAVERTEBRAL
SYMPATHETIC)
64530INJECTION, ANESTHETIC AGENT; CELIAC PLEXUS, WITH OR WITHOUT RADIOLOGIC
MONITORING
64620DESTRUCTION BY NEUROLYTIC AGENT, INTERCOSTAL NERVE
64640DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH

12
64999UNLISTED PROCEDURE, NERVOUS SYSTEM
Group 2

(9 Codes)

Group 2 Paragraph

CPT code 64450 is NOT medically necessary when billed with any other CPT code in the GROUP 2 Codes
listed PLUS any one of the GROUP 1 diagnosis listed in the ICD-10 Codes that DO NOT Support Medical
Necessity section below.

Group 2 Codes

Code Description
64450 INJECTION(S), ANESTHETIC AGENT(S) AND/OR STEROID; OTHER PERIPHERAL NERVE
OR BRANCH
76881 ULTRASOUND, COMPLETE JOINT (IE, JOINT SPACE AND PERI-ARTICULAR SOFT-TISSUE
STRUCTURES), REAL-TIME WITH IMAGE DOCUMENTATION
76882 ULTRASOUND, LIMITED, JOINT OR OTHER NONVASCULAR EXTREMITY STRUCTURE(S)
(EG, JOINT SPACE, PERI-ARTICULAR TENDON[S], MUSCLE[S], NERVE[S], OTHER
SOFT-TISSUE STRUCTURE[S], OR SOFT-TISSUE MASS[ES]), REAL-TIME WITH IMAGE
DOCUMENTATION
76942 ULTRASONIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION,
INJECTION, LOCALIZATION DEVICE), IMAGING SUPERVISION AND INTERPRETATION
76999 UNLISTED ULTRASOUND PROCEDURE (EG, DIAGNOSTIC, INTERVENTIONAL)
97032 APPLICATION OF A MODALITY TO 1 OR MORE AREAS; ELECTRICAL STIMULATION
(MANUAL), EACH 15 MINUTES
97139 UNLISTED THERAPEUTIC PROCEDURE (SPECIFY)
G0282ELECTRICAL STIMULATION, (UNATTENDED), TO ONE OR MORE AREAS, FOR WOUND
CARE OTHER THAN DESCRIBED IN G0281
G0283ELECTRICAL STIMULATION (UNATTENDED), TO ONE OR MORE AREAS FOR
INDICATION(S) OTHER THAN WOUND CARE, AS PART OF A THERAPY PLAN OF CARE
CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Expand All | Collapse All

Group 1

(495 Codes)

Group 1 Paragraph

The following list of ICD-10-CM codes support medical necessity for all Group 1 CPT codes listed in this
LCD (Somatic & epidural nerve block procedures). These diagnoses must be supported by appropriate
documentation of medical necessity in the medical record. These are the only covered diagnosis for Group 1
CPTs:

13
Group 1 Codes

Code Description
B02.0 Zoster encephalitis
B02.1 Zoster meningitis
B02.21 Postherpetic geniculate ganglionitis
B02.22 Postherpetic trigeminal neuralgia
B02.23 Postherpetic polyneuropathy
B02.24 Postherpetic myelitis
B02.29 Other postherpetic nervous system involvement
B02.7 Disseminated zoster
B02.8 Zoster with other complications
B02.9 Zoster without complications
G50.0 Trigeminal neuralgia
G54.0 Brachial plexus disorders
G54.1 Lumbosacral plexus disorders
G54.2 Cervical root disorders, not elsewhere classified
G54.3 Thoracic root disorders, not elsewhere classified
G54.4 Lumbosacral root disorders, not elsewhere classified
G54.5 Neuralgic amyotrophy
G54.6 Phantom limb syndrome with pain
G54.8 Other nerve root and plexus disorders
G55 Nerve root and plexus compressions in diseases classified elsewhere
G56.11 Other lesions of median nerve, right upper limb
G56.12 Other lesions of median nerve, left upper limb
G56.13 Other lesions of median nerve, bilateral upper limbs
G56.21 Lesion of ulnar nerve, right upper limb
G56.22 Lesion of ulnar nerve, left upper limb
G56.23 Lesion of ulnar nerve, bilateral upper limbs
G56.31 Lesion of radial nerve, right upper limb
G56.32 Lesion of radial nerve, left upper limb
G56.33 Lesion of radial nerve, bilateral upper limbs
G56.41 Causalgia of right upper limb
G56.42 Causalgia of left upper limb
G56.43 Causalgia of bilateral upper limbs
G56.81 Other specified mononeuropathies of right upper limb
G56.82 Other specified mononeuropathies of left upper limb
G56.91 Unspecified mononeuropathy of right upper limb
G56.92 Unspecified mononeuropathy of left upper limb
G57.01 Lesion of sciatic nerve, right lower limb
G57.02 Lesion of sciatic nerve, left lower limb
G57.03 Lesion of sciatic nerve, bilateral lower limbs
G57.11 Meralgia paresthetica, right lower limb
G57.12 Meralgia paresthetica, left lower limb
G57.13 Meralgia paresthetica, bilateral lower limbs
G57.21 Lesion of femoral nerve, right lower limb
G57.22 Lesion of femoral nerve, left lower limb
G57.23 Lesion of femoral nerve, bilateral lower limbs
G57.31 Lesion of lateral popliteal nerve, right lower limb
G57.32 Lesion of lateral popliteal nerve, left lower limb
G57.33 Lesion of lateral popliteal nerve, bilateral lower limbs

14
G57.41 Lesion of medial popliteal nerve, right lower limb
G57.42 Lesion of medial popliteal nerve, left lower limb
G57.43 Lesion of medial popliteal nerve, bilateral lower limbs
G57.71 Causalgia of right lower limb
G57.72 Causalgia of left lower limb
G57.73 Causalgia of bilateral lower limbs
G57.81 Other specified mononeuropathies of right lower limb
G57.82 Other specified mononeuropathies of left lower limb
G57.91* Unspecified mononeuropathy of right lower limb
G57.92* Unspecified mononeuropathy of left lower limb
G58.0 Intercostal neuropathy
G58.7* Mononeuritis multiplex
G58.8* Other specified mononeuropathies
G58.9* Mononeuropathy, unspecified
G59* Mononeuropathy in diseases classified elsewhere
G89.11 Acute pain due to trauma
G89.12 Acute post-thoracotomy pain
G89.18 Other acute postprocedural pain
G89.21 Chronic pain due to trauma
G89.22 Chronic post-thoracotomy pain
G89.28 Other chronic postprocedural pain
G89.3 Neoplasm related pain (acute) (chronic)
G90.50 Complex regional pain syndrome I, unspecified
G90.511 Complex regional pain syndrome I of right upper limb
G90.512 Complex regional pain syndrome I of left upper limb
G90.513 Complex regional pain syndrome I of upper limb, bilateral
G90.521 Complex regional pain syndrome I of right lower limb
G90.522 Complex regional pain syndrome I of left lower limb
G90.523 Complex regional pain syndrome I of lower limb, bilateral
G90.59 Complex regional pain syndrome I of other specified site
I73.00 Raynaud's syndrome without gangrene
I73.01 Raynaud's syndrome with gangrene
L74.510 Primary focal hyperhidrosis, axilla
L74.511 Primary focal hyperhidrosis, face
L74.512 Primary focal hyperhidrosis, palms
L74.513 Primary focal hyperhidrosis, soles
M25.511 Pain in right shoulder
M25.512 Pain in left shoulder
M25.551 Pain in right hip
M25.552 Pain in left hip
M25.561 Pain in right knee
M25.562 Pain in left knee
M43.27 Fusion of spine, lumbosacral region
M43.28 Fusion of spine, sacral and sacrococcygeal region
M46.1 Sacroiliitis, not elsewhere classified
M48.01 Spinal stenosis, occipito-atlanto-axial region
M48.02 Spinal stenosis, cervical region
M48.03 Spinal stenosis, cervicothoracic region
M48.04 Spinal stenosis, thoracic region
M48.05 Spinal stenosis, thoracolumbar region
M48.062 Spinal stenosis, lumbar region with neurogenic claudication

15
M50.11 Cervical disc disorder with radiculopathy, high cervical region
M50.121 Cervical disc disorder at C4-C5 level with radiculopathy
M50.122 Cervical disc disorder at C5-C6 level with radiculopathy
M50.123 Cervical disc disorder at C6-C7 level with radiculopathy
M50.13 Cervical disc disorder with radiculopathy, cervicothoracic region
M50.21 Other cervical disc displacement, high cervical region
M50.221 Other cervical disc displacement at C4-C5 level
M50.222 Other cervical disc displacement at C5-C6 level
M50.223 Other cervical disc displacement at C6-C7 level
M50.23 Other cervical disc displacement, cervicothoracic region
M50.31 Other cervical disc degeneration, high cervical region
M50.321 Other cervical disc degeneration at C4-C5 level
M50.322 Other cervical disc degeneration at C5-C6 level
M50.323 Other cervical disc degeneration at C6-C7 level
M50.33 Other cervical disc degeneration, cervicothoracic region
M51.14 Intervertebral disc disorders with radiculopathy, thoracic region
M51.15 Intervertebral disc disorders with radiculopathy, thoracolumbar region
M51.16 Intervertebral disc disorders with radiculopathy, lumbar region
M51.17 Intervertebral disc disorders with radiculopathy, lumbosacral region
M51.24 Other intervertebral disc displacement, thoracic region
M51.25 Other intervertebral disc displacement, thoracolumbar region
M51.34 Other intervertebral disc degeneration, thoracic region
M51.35 Other intervertebral disc degeneration, thoracolumbar region
M53.0 Cervicocranial syndrome
M53.2X7 Spinal instabilities, lumbosacral region
M53.2X8 Spinal instabilities, sacral and sacrococcygeal region
M53.3 Sacrococcygeal disorders, not elsewhere classified
M53.81 Other specified dorsopathies, occipito-atlanto-axial region
M53.82 Other specified dorsopathies, cervical region
M53.83 Other specified dorsopathies, cervicothoracic region
M53.86 Other specified dorsopathies, lumbar region
M53.87 Other specified dorsopathies, lumbosacral region
M53.88 Other specified dorsopathies, sacral and sacrococcygeal region
M54.10* Radiculopathy, site unspecified
M54.11 Radiculopathy, occipito-atlanto-axial region
M54.12 Radiculopathy, cervical region
M54.13 Radiculopathy, cervicothoracic region
M54.14 Radiculopathy, thoracic region
M54.15 Radiculopathy, thoracolumbar region
M54.16 Radiculopathy, lumbar region
M54.17 Radiculopathy, lumbosacral region
M54.18 Radiculopathy, sacral and sacrococcygeal region
M54.2 Cervicalgia
M54.31 Sciatica, right side
M54.32 Sciatica, left side
M54.41 Lumbago with sciatica, right side
M54.42 Lumbago with sciatica, left side
M54.51 Vertebrogenic low back pain
M54.59 Other low back pain
M54.6 Pain in thoracic spine
M54.81 Occipital neuralgia

16
M79.2* Neuralgia and neuritis, unspecified
M94.0 Chondrocostal junction syndrome [Tietze]
M96.1 Postlaminectomy syndrome, not elsewhere classified
M99.20 Subluxation stenosis of neural canal of head region
M99.21 Subluxation stenosis of neural canal of cervical region
M99.22 Subluxation stenosis of neural canal of thoracic region
M99.30 Osseous stenosis of neural canal of head region
M99.31 Osseous stenosis of neural canal of cervical region
M99.32 Osseous stenosis of neural canal of thoracic region
M99.40 Connective tissue stenosis of neural canal of head region
M99.41 Connective tissue stenosis of neural canal of cervical region
M99.42 Connective tissue stenosis of neural canal of thoracic region
M99.50 Intervertebral disc stenosis of neural canal of head region
M99.51 Intervertebral disc stenosis of neural canal of cervical region
M99.52 Intervertebral disc stenosis of neural canal of thoracic region
M99.60 Osseous and subluxation stenosis of intervertebral foramina of head region
M99.61 Osseous and subluxation stenosis of intervertebral foramina of cervical region
M99.62 Osseous and subluxation stenosis of intervertebral foramina of thoracic region
M99.70 Connective tissue and disc stenosis of intervertebral foramina of head region
M99.71 Connective tissue and disc stenosis of intervertebral foramina of cervical region
M99.72 Connective tissue and disc stenosis of intervertebral foramina of thoracic region
R07.1 Chest pain on breathing
R07.81 Pleurodynia
R07.9* Chest pain, unspecified
R10.10 Upper abdominal pain, unspecified
R10.11 Right upper quadrant pain
R10.12 Left upper quadrant pain
R10.13 Epigastric pain
R10.2 Pelvic and perineal pain
R10.30 Lower abdominal pain, unspecified
R10.31 Right lower quadrant pain
R10.32 Left lower quadrant pain
R10.33 Periumbilical pain
R25.0 Abnormal head movements
R25.1 Tremor, unspecified
R25.2 Cramp and spasm
R25.3 Fasciculation
R25.8 Other abnormal involuntary movements
R25.9 Unspecified abnormal involuntary movements
R44.0 Auditory hallucinations
R44.2 Other hallucinations
R44.3 Hallucinations, unspecified
R68.84 Jaw pain
S14.2XXAInjury of nerve root of cervical spine, initial encounter
S14.2XXDInjury of nerve root of cervical spine, subsequent encounter
S14.2XXS Injury of nerve root of cervical spine, sequela
S14.3XXAInjury of brachial plexus, initial encounter
S14.3XXDInjury of brachial plexus, subsequent encounter
S14.3XXS Injury of brachial plexus, sequela
S14.4XXAInjury of peripheral nerves of neck, initial encounter
S14.4XXDInjury of peripheral nerves of neck, subsequent encounter

17
S14.4XXS Injury of peripheral nerves of neck, sequela
S14.5XXAInjury of cervical sympathetic nerves, initial encounter
S14.5XXDInjury of cervical sympathetic nerves, subsequent encounter
S14.5XXS Injury of cervical sympathetic nerves, sequela
S14.8XXAInjury of other specified nerves of neck, initial encounter
S14.8XXDInjury of other specified nerves of neck, subsequent encounter
S14.8XXS Injury of other specified nerves of neck, sequela
S14.9XXAInjury of unspecified nerves of neck, initial encounter
S14.9XXDInjury of unspecified nerves of neck, subsequent encounter
S14.9XXS Injury of unspecified nerves of neck, sequela
S24.2XXAInjury of nerve root of thoracic spine, initial encounter
S24.2XXDInjury of nerve root of thoracic spine, subsequent encounter
S24.2XXS Injury of nerve root of thoracic spine, sequela
S24.3XXAInjury of peripheral nerves of thorax, initial encounter
S24.3XXDInjury of peripheral nerves of thorax, subsequent encounter
S24.3XXS Injury of peripheral nerves of thorax, sequela
S24.4XXAInjury of thoracic sympathetic nervous system, initial encounter
S24.4XXDInjury of thoracic sympathetic nervous system, subsequent encounter
S24.4XXS Injury of thoracic sympathetic nervous system, sequela
S24.8XXAInjury of other specified nerves of thorax, initial encounter
S24.8XXDInjury of other specified nerves of thorax, subsequent encounter
S24.8XXS Injury of other specified nerves of thorax, sequela
S24.9XXAInjury of unspecified nerve of thorax, initial encounter
S24.9XXDInjury of unspecified nerve of thorax, subsequent encounter
S24.9XXS Injury of unspecified nerve of thorax, sequela
S34.21XA Injury of nerve root of lumbar spine, initial encounter
S34.21XD Injury of nerve root of lumbar spine, subsequent encounter
S34.21XS Injury of nerve root of lumbar spine, sequela
S34.22XA Injury of nerve root of sacral spine, initial encounter
S34.22XD Injury of nerve root of sacral spine, subsequent encounter
S34.22XS Injury of nerve root of sacral spine, sequela
S34.4XXAInjury of lumbosacral plexus, initial encounter
S34.4XXDInjury of lumbosacral plexus, subsequent encounter
S34.4XXS Injury of lumbosacral plexus, sequela
S34.5XXAInjury of lumbar, sacral and pelvic sympathetic nerves, initial encounter
S34.5XXDInjury of lumbar, sacral and pelvic sympathetic nerves, subsequent encounter
S34.5XXS Injury of lumbar, sacral and pelvic sympathetic nerves, sequela
S34.6XXAInjury of peripheral nerve(s) at abdomen, lower back and pelvis level, initial encounter
S34.6XXDInjury of peripheral nerve(s) at abdomen, lower back and pelvis level, subsequent encounter
S34.6XXS Injury of peripheral nerve(s) at abdomen, lower back and pelvis level, sequela
S34.8XXAInjury of other nerves at abdomen, lower back and pelvis level, initial encounter
S34.8XXDInjury of other nerves at abdomen, lower back and pelvis level, subsequent encounter
S34.8XXS Injury of other nerves at abdomen, lower back and pelvis level, sequela
S34.9XXAInjury of unspecified nerves at abdomen, lower back and pelvis level, initial encounter
S34.9XXDInjury of unspecified nerves at abdomen, lower back and pelvis level, subsequent encounter
S34.9XXS Injury of unspecified nerves at abdomen, lower back and pelvis level, sequela
S44.01XA Injury of ulnar nerve at upper arm level, right arm, initial encounter
S44.01XD Injury of ulnar nerve at upper arm level, right arm, subsequent encounter
S44.01XS Injury of ulnar nerve at upper arm level, right arm, sequela
S44.02XA Injury of ulnar nerve at upper arm level, left arm, initial encounter
S44.02XD Injury of ulnar nerve at upper arm level, left arm, subsequent encounter

18
S44.02XS Injury of ulnar nerve at upper arm level, left arm, sequela
S44.11XA Injury of median nerve at upper arm level, right arm, initial encounter
S44.11XD Injury of median nerve at upper arm level, right arm, subsequent encounter
S44.11XS Injury of median nerve at upper arm level, right arm, sequela
S44.12XA Injury of median nerve at upper arm level, left arm, initial encounter
S44.12XD Injury of median nerve at upper arm level, left arm, subsequent encounter
S44.12XS Injury of median nerve at upper arm level, left arm, sequela
S44.21XA Injury of radial nerve at upper arm level, right arm, initial encounter
S44.21XD Injury of radial nerve at upper arm level, right arm, subsequent encounter
S44.21XS Injury of radial nerve at upper arm level, right arm, sequela
S44.22XA Injury of radial nerve at upper arm level, left arm, initial encounter
S44.22XD Injury of radial nerve at upper arm level, left arm, subsequent encounter
S44.22XS Injury of radial nerve at upper arm level, left arm, sequela
S44.30XA Injury of axillary nerve, unspecified arm, initial encounter
S44.30XD Injury of axillary nerve, unspecified arm, subsequent encounter
S44.30XS Injury of axillary nerve, unspecified arm, sequela
S44.31XA Injury of axillary nerve, right arm, initial encounter
S44.31XD Injury of axillary nerve, right arm, subsequent encounter
S44.31XS Injury of axillary nerve, right arm, sequela
S44.32XA Injury of axillary nerve, left arm, initial encounter
S44.32XD Injury of axillary nerve, left arm, subsequent encounter
S44.32XS Injury of axillary nerve, left arm, sequela
S44.41XA Injury of musculocutaneous nerve, right arm, initial encounter
S44.41XD Injury of musculocutaneous nerve, right arm, subsequent encounter
S44.41XS Injury of musculocutaneous nerve, right arm, sequela
S44.42XA Injury of musculocutaneous nerve, left arm, initial encounter
S44.42XD Injury of musculocutaneous nerve, left arm, subsequent encounter
S44.42XS Injury of musculocutaneous nerve, left arm, sequela
S44.51XA Injury of cutaneous sensory nerve at shoulder and upper arm level, right arm, initial encounter
S44.51XD Injury of cutaneous sensory nerve at shoulder and upper arm level, right arm, subsequent
encounter
S44.51XS Injury of cutaneous sensory nerve at shoulder and upper arm level, right arm, sequela
S44.52XA Injury of cutaneous sensory nerve at shoulder and upper arm level, left arm, initial encounter
S44.52XD Injury of cutaneous sensory nerve at shoulder and upper arm level, left arm, subsequent encounter
S44.52XS Injury of cutaneous sensory nerve at shoulder and upper arm level, left arm, sequela
S44.8X1A Injury of other nerves at shoulder and upper arm level, right arm, initial encounter
S44.8X1D Injury of other nerves at shoulder and upper arm level, right arm, subsequent encounter
S44.8X1S Injury of other nerves at shoulder and upper arm level, right arm, sequela
S44.8X2A Injury of other nerves at shoulder and upper arm level, left arm, initial encounter
S44.8X2D Injury of other nerves at shoulder and upper arm level, left arm, subsequent encounter
S44.8X2S Injury of other nerves at shoulder and upper arm level, left arm, sequela
S44.91XA Injury of unspecified nerve at shoulder and upper arm level, right arm, initial encounter
S44.91XD Injury of unspecified nerve at shoulder and upper arm level, right arm, subsequent encounter
S44.91XS Injury of unspecified nerve at shoulder and upper arm level, right arm, sequela
S44.92XA Injury of unspecified nerve at shoulder and upper arm level, left arm, initial encounter
S44.92XD Injury of unspecified nerve at shoulder and upper arm level, left arm, subsequent encounter
S44.92XS Injury of unspecified nerve at shoulder and upper arm level, left arm, sequela
S54.01XA Injury of ulnar nerve at forearm level, right arm, initial encounter
S54.01XD Injury of ulnar nerve at forearm level, right arm, subsequent encounter
S54.01XS Injury of ulnar nerve at forearm level, right arm, sequela
S54.02XA Injury of ulnar nerve at forearm level, left arm, initial encounter

19
S54.02XD Injury of ulnar nerve at forearm level, left arm, subsequent encounter
S54.02XS Injury of ulnar nerve at forearm level, left arm, sequela
S54.11XA Injury of median nerve at forearm level, right arm, initial encounter
S54.11XD Injury of median nerve at forearm level, right arm, subsequent encounter
S54.11XS Injury of median nerve at forearm level, right arm, sequela
S54.12XA Injury of median nerve at forearm level, left arm, initial encounter
S54.12XD Injury of median nerve at forearm level, left arm, subsequent encounter
S54.12XS Injury of median nerve at forearm level, left arm, sequela
S54.21XA Injury of radial nerve at forearm level, right arm, initial encounter
S54.21XD Injury of radial nerve at forearm level, right arm, subsequent encounter
S54.21XS Injury of radial nerve at forearm level, right arm, sequela
S54.22XA Injury of radial nerve at forearm level, left arm, initial encounter
S54.22XD Injury of radial nerve at forearm level, left arm, subsequent encounter
S54.22XS Injury of radial nerve at forearm level, left arm, sequela
S54.31XA Injury of cutaneous sensory nerve at forearm level, right arm, initial encounter
S54.31XD Injury of cutaneous sensory nerve at forearm level, right arm, subsequent encounter
S54.31XS Injury of cutaneous sensory nerve at forearm level, right arm, sequela
S54.32XA Injury of cutaneous sensory nerve at forearm level, left arm, initial encounter
S54.32XD Injury of cutaneous sensory nerve at forearm level, left arm, subsequent encounter
S54.32XS Injury of cutaneous sensory nerve at forearm level, left arm, sequela
S54.8X1A Injury of other nerves at forearm level, right arm, initial encounter
S54.8X1D Injury of other nerves at forearm level, right arm, subsequent encounter
S54.8X1S Injury of other nerves at forearm level, right arm, sequela
S54.8X2A Injury of other nerves at forearm level, left arm, initial encounter
S54.8X2D Injury of other nerves at forearm level, left arm, subsequent encounter
S54.8X2S Injury of other nerves at forearm level, left arm, sequela
S54.91XA Injury of unspecified nerve at forearm level, right arm, initial encounter
S54.91XD Injury of unspecified nerve at forearm level, right arm, subsequent encounter
S54.91XS Injury of unspecified nerve at forearm level, right arm, sequela
S54.92XA Injury of unspecified nerve at forearm level, left arm, initial encounter
S54.92XD Injury of unspecified nerve at forearm level, left arm, subsequent encounter
S54.92XS Injury of unspecified nerve at forearm level, left arm, sequela
S64.01XA Injury of ulnar nerve at wrist and hand level of right arm, initial encounter
S64.01XD Injury of ulnar nerve at wrist and hand level of right arm, subsequent encounter
S64.01XS Injury of ulnar nerve at wrist and hand level of right arm, sequela
S64.02XA Injury of ulnar nerve at wrist and hand level of left arm, initial encounter
S64.02XD Injury of ulnar nerve at wrist and hand level of left arm, subsequent encounter
S64.02XS Injury of ulnar nerve at wrist and hand level of left arm, sequela
S64.11XA Injury of median nerve at wrist and hand level of right arm, initial encounter
S64.11XD Injury of median nerve at wrist and hand level of right arm, subsequent encounter
S64.11XS Injury of median nerve at wrist and hand level of right arm, sequela
S64.12XA Injury of median nerve at wrist and hand level of left arm, initial encounter
S64.12XD Injury of median nerve at wrist and hand level of left arm, subsequent encounter
S64.12XS Injury of median nerve at wrist and hand level of left arm, sequela
S64.21XA Injury of radial nerve at wrist and hand level of right arm, initial encounter
S64.21XD Injury of radial nerve at wrist and hand level of right arm, subsequent encounter
S64.21XS Injury of radial nerve at wrist and hand level of right arm, sequela
S64.22XA Injury of radial nerve at wrist and hand level of left arm, initial encounter
S64.22XD Injury of radial nerve at wrist and hand level of left arm, subsequent encounter
S64.22XS Injury of radial nerve at wrist and hand level of left arm, sequela
S64.31XA Injury of digital nerve of right thumb, initial encounter

20
S64.31XD Injury of digital nerve of right thumb, subsequent encounter
S64.31XS Injury of digital nerve of right thumb, sequela
S64.32XA Injury of digital nerve of left thumb, initial encounter
S64.32XD Injury of digital nerve of left thumb, subsequent encounter
S64.32XS Injury of digital nerve of left thumb, sequela
S64.490A Injury of digital nerve of right index finger, initial encounter
S64.490D Injury of digital nerve of right index finger, subsequent encounter
S64.490S Injury of digital nerve of right index finger, sequela
S64.491A Injury of digital nerve of left index finger, initial encounter
S64.491D Injury of digital nerve of left index finger, subsequent encounter
S64.491S Injury of digital nerve of left index finger, sequela
S64.492A Injury of digital nerve of right middle finger, initial encounter
S64.492D Injury of digital nerve of right middle finger, subsequent encounter
S64.492S Injury of digital nerve of right middle finger, sequela
S64.493A Injury of digital nerve of left middle finger, initial encounter
S64.493D Injury of digital nerve of left middle finger, subsequent encounter
S64.493S Injury of digital nerve of left middle finger, sequela
S64.494A Injury of digital nerve of right ring finger, initial encounter
S64.494D Injury of digital nerve of right ring finger, subsequent encounter
S64.494S Injury of digital nerve of right ring finger, sequela
S64.495A Injury of digital nerve of left ring finger, initial encounter
S64.495D Injury of digital nerve of left ring finger, subsequent encounter
S64.495S Injury of digital nerve of left ring finger, sequela
S64.496A Injury of digital nerve of right little finger, initial encounter
S64.496D Injury of digital nerve of right little finger, subsequent encounter
S64.496S Injury of digital nerve of right little finger, sequela
S64.497A Injury of digital nerve of left little finger, initial encounter
S64.497D Injury of digital nerve of left little finger, subsequent encounter
S64.497S Injury of digital nerve of left little finger, sequela
S64.498A Injury of digital nerve of other finger, initial encounter
S64.498D Injury of digital nerve of other finger, subsequent encounter
S64.498S Injury of digital nerve of other finger, sequela
S64.8X1A Injury of other nerves at wrist and hand level of right arm, initial encounter
S64.8X1D Injury of other nerves at wrist and hand level of right arm, subsequent encounter
S64.8X1S Injury of other nerves at wrist and hand level of right arm, sequela
S64.8X2A Injury of other nerves at wrist and hand level of left arm, initial encounter
S64.8X2D Injury of other nerves at wrist and hand level of left arm, subsequent encounter
S64.8X2S Injury of other nerves at wrist and hand level of left arm, sequela
S64.91XA Injury of unspecified nerve at wrist and hand level of right arm, initial encounter
S64.91XD Injury of unspecified nerve at wrist and hand level of right arm, subsequent encounter
S64.91XS Injury of unspecified nerve at wrist and hand level of right arm, sequela
S64.92XA Injury of unspecified nerve at wrist and hand level of left arm, initial encounter
S64.92XD Injury of unspecified nerve at wrist and hand level of left arm, subsequent encounter
S64.92XS Injury of unspecified nerve at wrist and hand level of left arm, sequela
S74.01XA Injury of sciatic nerve at hip and thigh level, right leg, initial encounter
S74.01XD Injury of sciatic nerve at hip and thigh level, right leg, subsequent encounter
S74.01XS Injury of sciatic nerve at hip and thigh level, right leg, sequela
S74.02XA Injury of sciatic nerve at hip and thigh level, left leg, initial encounter
S74.02XD Injury of sciatic nerve at hip and thigh level, left leg, subsequent encounter
S74.02XS Injury of sciatic nerve at hip and thigh level, left leg, sequela
S74.11XA Injury of femoral nerve at hip and thigh level, right leg, initial encounter

21
S74.11XD Injury of femoral nerve at hip and thigh level, right leg, subsequent encounter
S74.11XS Injury of femoral nerve at hip and thigh level, right leg, sequela
S74.12XA Injury of femoral nerve at hip and thigh level, left leg, initial encounter
S74.12XD Injury of femoral nerve at hip and thigh level, left leg, subsequent encounter
S74.12XS Injury of femoral nerve at hip and thigh level, left leg, sequela
S74.21XA Injury of cutaneous sensory nerve at hip and high level, right leg, initial encounter
S74.21XD Injury of cutaneous sensory nerve at hip and high level, right leg, subsequent encounter
S74.21XS Injury of cutaneous sensory nerve at hip and high level, right leg, sequela
S74.22XA Injury of cutaneous sensory nerve at hip and thigh level, left leg, initial encounter
S74.22XD Injury of cutaneous sensory nerve at hip and thigh level, left leg, subsequent encounter
S74.22XS Injury of cutaneous sensory nerve at hip and thigh level, left leg, sequela
S74.8X1A Injury of other nerves at hip and thigh level, right leg, initial encounter
S74.8X1D Injury of other nerves at hip and thigh level, right leg, subsequent encounter
S74.8X1S Injury of other nerves at hip and thigh level, right leg, sequela
S74.8X2A Injury of other nerves at hip and thigh level, left leg, initial encounter
S74.8X2D Injury of other nerves at hip and thigh level, left leg, subsequent encounter
S74.8X2S Injury of other nerves at hip and thigh level, left leg, sequela
S74.91XA Injury of unspecified nerve at hip and thigh level, right leg, initial encounter
S74.91XD Injury of unspecified nerve at hip and thigh level, right leg, subsequent encounter
S74.91XS Injury of unspecified nerve at hip and thigh level, right leg, sequela
S74.92XA Injury of unspecified nerve at hip and thigh level, left leg, initial encounter
S74.92XD Injury of unspecified nerve at hip and thigh level, left leg, subsequent encounter
S74.92XS Injury of unspecified nerve at hip and thigh level, left leg, sequela
S84.01XA Injury of tibial nerve at lower leg level, right leg, initial encounter
S84.01XD Injury of tibial nerve at lower leg level, right leg, subsequent encounter
S84.01XS Injury of tibial nerve at lower leg level, right leg, sequela
S84.02XA Injury of tibial nerve at lower leg level, left leg, initial encounter
S84.02XD Injury of tibial nerve at lower leg level, left leg, subsequent encounter
S84.02XS Injury of tibial nerve at lower leg level, left leg, sequela
S84.11XA Injury of peroneal nerve at lower leg level, right leg, initial encounter
S84.11XD Injury of peroneal nerve at lower leg level, right leg, subsequent encounter
S84.11XS Injury of peroneal nerve at lower leg level, right leg, sequela
S84.12XA Injury of peroneal nerve at lower leg level, left leg, initial encounter
S84.12XD Injury of peroneal nerve at lower leg level, left leg, subsequent encounter
S84.12XS Injury of peroneal nerve at lower leg level, left leg, sequela
S84.21XA Injury of cutaneous sensory nerve at lower leg level, right leg, initial encounter
S84.21XD Injury of cutaneous sensory nerve at lower leg level, right leg, subsequent encounter
S84.21XS Injury of cutaneous sensory nerve at lower leg level, right leg, sequela
S84.22XA Injury of cutaneous sensory nerve at lower leg level, left leg, initial encounter
S84.22XD Injury of cutaneous sensory nerve at lower leg level, left leg, subsequent encounter
S84.22XS Injury of cutaneous sensory nerve at lower leg level, left leg, sequela
S84.801A Injury of other nerves at lower leg level, right leg, initial encounter
S84.801D Injury of other nerves at lower leg level, right leg, subsequent encounter
S84.801S Injury of other nerves at lower leg level, right leg, sequela
S84.802A Injury of other nerves at lower leg level, left leg, initial encounter
S84.802D Injury of other nerves at lower leg level, left leg, subsequent encounter
S84.802S Injury of other nerves at lower leg level, left leg, sequela
S84.91XA Injury of unspecified nerve at lower leg level, right leg, initial encounter
S84.91XD Injury of unspecified nerve at lower leg level, right leg, subsequent encounter
S84.91XS Injury of unspecified nerve at lower leg level, right leg, sequela
S84.92XA Injury of unspecified nerve at lower leg level, left leg, initial encounter

22
S84.92XD Injury of unspecified nerve at lower leg level, left leg, subsequent encounter
S84.92XS Injury of unspecified nerve at lower leg level, left leg, sequela
S94.01XA Injury of lateral plantar nerve, right leg, initial encounter
S94.01XD Injury of lateral plantar nerve, right leg, subsequent encounter
S94.01XS Injury of lateral plantar nerve, right leg, sequela
S94.02XA Injury of lateral plantar nerve, left leg, initial encounter
S94.02XD Injury of lateral plantar nerve, left leg, subsequent encounter
S94.02XS Injury of lateral plantar nerve, left leg, sequela
S94.11XA Injury of medial plantar nerve, right leg, initial encounter
S94.11XD Injury of medial plantar nerve, right leg, subsequent encounter
S94.11XS Injury of medial plantar nerve, right leg, sequela
S94.12XA Injury of medial plantar nerve, left leg, initial encounter
S94.12XD Injury of medial plantar nerve, left leg, subsequent encounter
S94.12XS Injury of medial plantar nerve, left leg, sequela
S94.21XA Injury of deep peroneal nerve at ankle and foot level, right leg, initial encounter
S94.21XD Injury of deep peroneal nerve at ankle and foot level, right leg, subsequent encounter
S94.21XS Injury of deep peroneal nerve at ankle and foot level, right leg, sequela
S94.22XA Injury of deep peroneal nerve at ankle and foot level, left leg, initial encounter
S94.22XD Injury of deep peroneal nerve at ankle and foot level, left leg, subsequent encounter
S94.22XS Injury of deep peroneal nerve at ankle and foot level, left leg, sequela
S94.31XA Injury of cutaneous sensory nerve at ankle and foot level, right leg, initial encounter
S94.31XD Injury of cutaneous sensory nerve at ankle and foot level, right leg, subsequent encounter
S94.31XS Injury of cutaneous sensory nerve at ankle and foot level, right leg, sequela
S94.32XA Injury of cutaneous sensory nerve at ankle and foot level, left leg, initial encounter
S94.32XD Injury of cutaneous sensory nerve at ankle and foot level, left leg, subsequent encounter
S94.32XS Injury of cutaneous sensory nerve at ankle and foot level, left leg, sequela
S94.8X1A Injury of other nerves at ankle and foot level, right leg, initial encounter
S94.8X1D Injury of other nerves at ankle and foot level, right leg, subsequent encounter
S94.8X1S Injury of other nerves at ankle and foot level, right leg, sequela
S94.8X2A Injury of other nerves at ankle and foot level, left leg, initial encounter
S94.8X2D Injury of other nerves at ankle and foot level, left leg, subsequent encounter
S94.8X2S Injury of other nerves at ankle and foot level, left leg, sequela
S94.91XA Injury of unspecified nerve at ankle and foot level, right leg, initial encounter
S94.91XD Injury of unspecified nerve at ankle and foot level, right leg, subsequent encounter
S94.91XS Injury of unspecified nerve at ankle and foot level, right leg, sequela
S94.92XA Injury of unspecified nerve at ankle and foot level, left leg, initial encounter
S94.92XD Injury of unspecified nerve at ankle and foot level, left leg, subsequent encounter
S94.92XS Injury of unspecified nerve at ankle and foot level, left leg, sequela
Z48.3 Aftercare following surgery for neoplasm
Z48.89 Encounter for other specified surgical aftercare
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*R07.9 is used to describe rib pain.

*G57.91, G57.92, G58.7, G58.8, G58.9, G59, M54.10 and M79.2 will be denied if 64450 is billed with CPT
codes 76881, 76882, 76942, 76999, 97032, 97139, G0282 and/or G0283 on the same date of service (DOS).
(Please see information in the ICD-10 Codes that DO NOT Support Medical Necessity section below).

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

Expand All | Collapse All

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Group 1

(25 Codes)

Group 1 Paragraph

All the ICD-10-CM codes listed below DO NOT support medical necessity and will deny when billing
64450 WITH 76881, 76882, 76942, 76999, 97032, 97139, G0282 and/or G0283 (above Group 2 CPT codes)
for peripheral nerve blocks (including G57.91, G57.92, G58.7, G58.8, G58.9 G59, M54.10 and M79.2). Refer
to the Coverage and Limitations section above.

All other ICD-10-CM codes not listed in this policy under "ICD-10 Codes that Support Medical Necessity"
above.

Group 1 Codes

Code Description
G60.0 Hereditary motor and sensory neuropathy
G60.1 Refsum's disease
G60.2 Neuropathy in association with hereditary ataxia
G60.3 Idiopathic progressive neuropathy
G60.8 Other hereditary and idiopathic neuropathies
G60.9 Hereditary and idiopathic neuropathy, unspecified
G61.0 Guillain-Barre syndrome
G61.1 Serum neuropathy
G61.81 Chronic inflammatory demyelinating polyneuritis
G61.89 Other inflammatory polyneuropathies
G61.9 Inflammatory polyneuropathy, unspecified
G62.0 Drug-induced polyneuropathy
G62.2 Polyneuropathy due to other toxic agents
G62.81 Critical illness polyneuropathy
G62.82 Radiation-induced polyneuropathy
G62.89 Other specified polyneuropathies
G63 Polyneuropathy in diseases classified elsewhere
M25.571 Pain in right ankle and joints of right foot
M25.572 Pain in left ankle and joints of left foot
R20.0 Anesthesia of skin
R20.1 Hypoesthesia of skin
R20.2 Paresthesia of skin
R20.3 Hyperesthesia
R20.8 Other disturbances of skin sensation
R20.9 Unspecified disturbances of skin sensation
ICD-10-PCS Codes

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

24
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this
service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete
absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be
assumed to apply equally to all claims.

Code Description
999x Not Applicable
Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to
report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article,
services reported under other Revenue Codes are equally subject to this coverage determination. Complete
absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article
should be assumed to apply equally to all Revenue Codes.

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to
report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy
services reported under other Revenue Codes are equally subject to this coverage determination. Complete
absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy
should be assumed to apply equally to all Revenue Codes.

N/A

Other Coding Information

N/A

Revision History Information

Revision Revision
History History
Date Number Revision History Explanation
09/04/2022R7 No Comments received within the specified Comment Period for the Proposed LCD
and associated Billing and Coding article. No changes made to this LCD related
Billing and coding article.
10/01/2021R6 Added the following two diagnosis codes to replace the deleted code M54.5 Low
back pain per the Annual ICD-10-CM Update effective 10/01/2021.

• M54.51 - Vertebrogenic low back pain

• M54.59 - Other low back pain
01/01/2021R5 Added the statement "Effective 01/01/2020, 64999 is to be used to report injections of
anesthetic and/or steroids for the facial and phrenic nerves and cervical plexus. This
code replaces the deleted codes 64402, 64410 and 64413" to the Group 1 Paragraph
and added 64999 to the list of Group 1 Codes in the CPT/HCPCS Codes section.

This update was inadvertently missed with the 01/01/2020 Annual Update when
64402, 64410 and 64413 were deleted.

01/01/2021R4

25
 CPT descriptions changed for the following CPT® codes per the 2021 Annual CPT®
update.

• 64479 from INJECTION(s), ANESTHETIC AGENT AND/ OR STEROID,

TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE
(FLUOROSCOPY OR CT); CERVICAL OR THORACIC, SINGLE
LEVEL to INJECTION(s), ANESTHETIC AGENT(s) AND/ OR STEROID;
TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE
(FLUOROSCOPY OR CT), CERVICAL OR THORACIC, SINGLE LEVEL
and
• 64480 from INJECTION(s), ANESTHETIC AGENT AND/ OR STEROID,
TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE
(FLUOROSCOPY OR CT); CERVICAL OR THORACIC, EACH
ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE
FOR PRIMARY PROCEDURE) to INJECTION(s), ANESTHETIC
AGENT(s) AND/ OR STEROID, TRANSFORAMINAL EPIDURAL, WITH
IMAGING GUIDANCE (FLUOROSCOPY OR CT); CERVICAL OR
THORACIC, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN
ADDITION TO CODE FOR PRIMARY PROCEDURE).
01/01/2020R3 The billing and coding article for the Nerve Blockade for Treatment of Chronic Pain
and Neuropathy Policy Local Coverage Determination (LCD) is revised to add CPT
code 64451, effective January 1, 2020.

The following CPT code descriptors were changed in group 1: 64405, 64408, 64415,
64417, 64418, 64420, 64421, 64425, 64430, 64435, 64445, 64446, 64447, 64448,
64449, 64450. CPT Codes 64402, 64410 and 64413 are deleted and removed from
Group 1 also effective January 1, 2020.

12/01/2019R2 This article was converted to a Billing and Coding Article type and is to be used with
its associated Local Coverage Determination.

The article title was changed to from "Peripheral Nerve Blocks Non-covered for the
Treatment of Diabetic Peripheral Neuropathic Pain" to "Billing and Coding: Nerve
Blockade for Treatment of Chronic Pain and Neuropathy" to match the title of the
LCD.

The sentence The effective date of this article corresponds to the effective date of the
JE Part A and Part B Nerve Blockade for Treatment of Chronic Pain and Neuropathy
of 10/01/2015 was removed as the effective date of the article has changed.
10/01/2015R1 Added hyperlinks to the first two articles and deleted the third under Sources. Also,
this article is revised to combine the Jurisdiction F Part B (JFB) Local Coverage
Article A52724 into the Jurisdiction F Part A (JFA) article A52275 so that both JFA
and JFB contract numbers will have the same final MCD article number as JFA with
the same effective date of 10/01/2015 and no change in coverage.
Associated Documents

Related Local Coverage Documents

Articles
A59155 - Response to Comments: Nerve Blockade for Treatment of Chronic Pain and Neuropathy

26
LCDs
L35457 - Nerve Blockade for Treatment of Chronic Pain and Neuropathy

Related National Coverage Documents

N/A

Statutory Requirements URLs

N/A

Rules and Regulations URLs

N/A

CMS Manual Explanations URLs

N/A

Other URLs
N/A

Public Versions

Updated On Effective Dates Status

07/14/2022 09/04/2022 - N/A Future Effective You are here

URL for source document:

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=59155&ver=3

Article Title
Response to Comments: Nerve Blockade for Treatment of Chronic Pain and Neuropathy

Article Type
Response to Comments

AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2021 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

27
not contained herein.

Current Dental Terminology © 2021 American Dental Association. All rights reserved.

Copyright © 2013 - 2022, the American Hospital Association, Chicago, Illinois. Reproduced by CMS 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. To
license the electronic data file of UB-04 Data Specifications, contact Tim Carlson at (312) 893-6816. You
may also contact us at [email protected].

Article Guidance

Article Text

The Proposed Nerve Blockade for Treatment of Chronic Pain and Neuropathy Local Coverage Determination
(LCD) was posted for comment by Noridian Healthcare Solutions (NHS) on April 28, 2022 through June 11,
2022 and presented at the May 26, 2022 Open Meeting for NHS. No comments were received within
specified Comment Period.

The Final LCD will be viewable on the CMS Medicare Coverage Database (MCD) on July 21, 2022 which
starts 45-day Notice Period. This Final LCD will be effective 9/4/2022.

Response To Comments

Number Comment Response

1 N/A N/A
Associated Documents

Related Local Coverage Documents

Articles
A52725 - Billing and Coding: Nerve Blockade for Treatment of Chronic Pain and Neuropathy
LCDs
L35457 - Nerve Blockade for Treatment of Chronic Pain and Neuropathy

Related National Coverage Documents

N/A

Public Versions

Updated On Effective Dates Status

07/14/2022 09/04/2022 - N/A Future Effective You are here

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