About this policy
Jurisdiction: JJ Part B. States: Alabama, Georgia, Tennessee. Type: Active LCD
Coverage indications
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.
Codes in this policy
Code numbers and each code’s status as the policy records it. CPT code descriptions are left out of this page, as are the passages that cite CPT codes; the official document has them.
| Code | Code system | Status in this policy |
|---|---|---|
| 64450 | CPT | Covered |
| 97032 | CPT | Covered |
| 97139 | CPT | Covered |
| G0282 | HCPCS | Covered |
| G0283 | HCPCS | Covered |
| A52.15 | ICD10CM | Not covered |
| E08.40 | ICD10CM | Not covered |
| E08.41 | ICD10CM | Not covered |
| E08.42 | ICD10CM | Not covered |
| E08.43 | ICD10CM | Not covered |
| E09.40 | ICD10CM | Not covered |
| E09.41 | ICD10CM | Not covered |