LCD L35222

Coverage Guidance

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

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

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

CMS Pub 100-03 Medicare National Coverage Determinations (NCD) Manual Chapter - 1 Sections:

30.3 – Acupuncture

150.7 - Prolotherapy, Joint Sclerotherapy, and Ligamentous Injections with Sclerosing Agents

150.6 -Vitamin B12 Injections to Strengthen Tendons, Ligaments, etc., of the Foot

Indications and Limitations of Coverage

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

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

Limitations

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

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

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

Summary of Evidence

N/A

Analysis of Evidence

N/A

Associated Information

Utilization Guidelines

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

Bibliography

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

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

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

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

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