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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
The rules state that Peripheral nerves can be the cause of pain in a variety of conditions. Sometimes the nerves 
are the source of the pain and sometimes the nerves merely are carrying impulses from painful tissues. 
Examples may include post-herniorrhaphy pain (ilioinguinal/iliohypogastric/genitofemoral), iliac crest harvest 
syndromes (cluneal nerve, lateral femoral cutaneous nerve), carpal tunnel syndrome (median nerve), Mortons 
neuroma, facial pain and headaches (trigeminal and occipital nerve). 
 
Peripheral nerve blocks may be used for both diagnostic and therapeutic purposes. Diagnostically, a peripheral 
nerve block allows the clinician to isolate the specific cause of pain in an individual patient. The injection of 
local anesthetic, with or without steroid may also provide an extended therapeutic benefit. If the patient does 
not achieve sustained relief a denervation procedure via chemical, cryoneurolysis or radiofrequency may not be 
effective at providing long term relief. 
 
Indications: 
 
Peripheral nerve blocks will be considered medically reasonable and necessary for normally temporary 
conditions such as the following diagnostic and therapeutic purposes: 
1. When the patients pain appears to be due to a classic mononeuritis but the neuro-diagnostic studies 
have failed to provide a structural explanation, selective peripheral nerve blockade can usually clarify 
the situation but this is only for diagnostic purposes and not long term treatment.  
2. When peripheral nerve injuries/entrapment or other extremity trauma leads to complex regional pain 
syndrome.  
3. When selective peripheral nerve blockade is used diagnostically in those cases in which the clinical 
picture is unclear but this is only for diagnostic purposes and not long term treatment.  
4. When an occipital nerve block is used to confirm the clinical impression of the presence of occipital 
neuralgia. Chronic headache/occipital neuralgia can result from chronic spasm of the neck muscles as 
the result of either myofascial syndrome or underlying cervical spinal disease. It may be unilateral or 
bilateral, constant or intermittent. Nerve injury secondary to localized head trauma or trauma to the 
nerve from a scalp laceration can also cause this condition. Most commonly it is caused by an 
entrapment of the occipital nerve in its course from its origin from the C2 nerve root to its entrance into the scalp through the mid portion of the superior nuchal line. Blockage of the occipital nerve can 
confirm the clinical impression of occipital neuralgia particularly if the clinical picture is not entirely 
typical. If only temporary relief of symptoms is obtained, neurolysis of the greater occipital nerve may 
be considered via multiple techniques including radiofrequency and cryoanalgesia. In addition, the 
lesser and third occipital nerves can be involved in the pathology of headaches and can be treated in a 
similar manner. 
5. When the suprascapular nerve block is used to confirm the diagnosis of suspected entrapment of the 
nerve. Entrapment of the suprascapular nerve as it passes through the suprascapular notch can produce a 
syndrome of pain within the shoulder with weakness of supraspinatus and infraspinatus muscles. When 
the history and examination point to the diagnosis, a suprascapular nerve block leading to relief of pain 
can confirm it. This may be followed by injection of depository steroids that sometime provide lasting 
relief. 
6. When the trigeminal nerve is blocked centrally at the trigeminal ganglion, or along one of the three 
divisions or at one of the many peripheral terminal branches (i.e., supraorbital nerve). 
7. Nerve blocks as preemptive analgesia 
 A. When a single injection peripheral nerve block provides post-surgical pain control 
1. during the transition to oral analgesics 
2. in those procedures which cause severe pain normally uncontrolled by oral analgesics 
3. in cases otherwise requiring control with intravenous or parenteral narcotics. 
4. in cases where the patient cannot tolerate treatment with narcotics due to allergy or side effects, etc. 
 B. When a continuous peripheral nerve block provides the same as above, and furthermore may provide 
extended (i.e. one to five or more days) relief as a result of chronic administration of anesthetic. 
Additional management using medications, behavioral therapy, and physical therapy should be used (when 
appropriate) in conjunction with peripheral nerve block. 
 
Injection of depository steroids, may offer only temporary relief. In some cases, neurolysis may be appropriate 
to provide lasting relief. 
 
Preemptive analgesia starts before surgery, and a presumption of medical necessity is being made before the 
fact. Therefore, based on generally accepted clinical standards and evidence in peer reviewed medical literature 
the surgical procedure must be of such nature that the patient would benefit from the preemptive analgesia. 
However, its billing must conform to National Correct Coding Initiative edit policy. (NCCI Policy Manual for 
Medicare Services Chapter II Anesthesia Services) 
Limitations: 
 
The signs and symptoms that justify peripheral nerve blocks should be resolved after one to three injections at a 
specific site. They cannot be for clinical situations as mentioned below where nerve blocks are not medically 
necessary as per this LCD. More than three injections per anatomic site (e.g., specific nerve, plexus or branch 
as defined by the CPT code description) in a six month period will be denied. These blocks should last at least 
two months in order to be deemed successful. In rare exceptions with appropriate documentation, there is a 
limit of three blocks per six month period. More than two anatomic sites (e.g., specific nerve, plexus or branch as defined by the CPT code description) 
injected at any one session will be denied. If the patient does not achieve progressively sustained relief after 
receiving two to three repeat peripheral nerve block injections on the same anatomical site, then alternative 
therapeutic options should be explored. 
There is insufficient evidence to support the use of peripheral nerve blocks in the treatment of diabetic 
peripheral neuropathy, peripheral neuropathies caused by other underlying systemic diseases or peripheral 
neuropathies causes such as degenerative or idiopathic reasons. 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. 
The use of ultrasound guidance in conjunction with these non-covered injections is also considered not 
medically necessary and will result in denial. 
 
Note: the term "Morton's neuroma" is used in this document generically to refer to a swollen inflamed nerve in 
the ball of the foot, including the more specific conditions of Morton's neuroma (lesion within the third 
intermetatarsal space), Heuter's neuroma (first intermetatarsal space), Hauser's neuroma (second intermetatarsal 
space) and Iselin's neuroma (fourth intermetatarsal space). This LCD applies to each such condition. 
 
Injection into neuromas may be indicated to relieve pain or dysfunction resulting from inflammation or other 
pathological changes. Proper use of this modality with local anesthetics and/or steroids should be short- term, 
as part of an overall management plan including diagnostic evaluation, in order to clearly identify and properly 
treat the primary cause. 
 
Medical necessity for injections of more than two sites at one session or for frequent or repeated injections is 
questionable and not supported by peer literature that is indexed in PubMed of the US National Library of 
Medicine of the National Institutes of Health (NIH). 
 
"Dry needling" of ganglion cysts, ligaments, neuromas, peripheral nerves, tendon sheaths and their 
origins/insertions, or any tissue are non-covered procedures. 
You can find this rule at Centers for Medicare and Medicaid Services, Local Coverage Determination (LCD) 
L36850, Peripheral Nerve Blocks. 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.