Peripheral nerv blocks

[PinchandBurn]

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This new LCD for peripheral nerve blcoks looks very intense.

Anyone figure it out yet?

I guess its starting Oct 2026.

 

[callmeanesthesia]

It looks like we lose coverage of almost all peripheral nerve blocks done for chronic pain. Some variation between the MACs though. I’m in Noridian. Genicular RFA covered only for KL grade 3-4 knee OA, in patients who are not surgical candidates, not covered for postoperative knee pain. Cryoablation not covered outside the perioperative period. Occipital covered for acute occipital neuralgia but diagnostic block required first. Max 4/year. Suprascapular is permitted within limited criteria and after diagnostic block, max 2 per year.

 

[powermd]

Post links too these "per contractor" versions. The LCD I just looked at said the effective date was 11/1/2026

 

[cowboydoc]

It looks like we lose coverage of almost all peripheral nerve blocks done for chronic pain. Some variation between the MACs though. I’m in Noridian. Genicular RFA covered only for KL grade 3-4 knee OA, in patients who are not surgical candidates, not covered for postoperative knee pain. Cryoablation not covered outside the perioperative period. Occipital covered for acute occipital neuralgia but diagnostic block required first. Max 4/year. Suprascapular is permitted within limited criteria and after diagnostic block, max 2 per year.

So backwards. Cryo perioperatively is a perk. Cryo or RF is one of the few tools we have for post-TKA pain. I guess they want to pay for a lot more stim for “crps.”

 

[Laryngospasm]

Soon Stim will be such a huge outlier it will get nerfed. For sure.

 

[PinchandBurn]

Soon Stim will be such a huge outlier it will get nerfed. For sure.

Yeah but until then..scs and PNS

 

[Laryngospasm]

I wouldn’t be surprised if one of the goals of the asm is to show that scs doesn’t provide improved outcomes or some such ….along with others.. do their own study, massage the data, eliminate procedures as”non-essential” “showing no improvement” etc

 

[Ferrismonk]

It looks like we lose coverage of almost all peripheral nerve blocks done for chronic pain. Some variation between the MACs though. I’m in Noridian. Genicular RFA covered only for KL grade 3-4 knee OA, in patients who are not surgical candidates, not covered for postoperative knee pain. Cryoablation not covered outside the perioperative period. Occipital covered for acute occipital neuralgia but diagnostic block required first. Max 4/year. Suprascapular is permitted within limited criteria and after diagnostic block, max 2 per year.

Its so frickin annoying to do diagnostic blocks for joint or nerve blocks. Its the exact same procedure, just without steroid. So they want me to do 2-3 procedures instead of one, just so the patient can wait a month or two without relief, all for a $46 procedure. So stupid.

 

[callmeanesthesia]

I’m not aware of any practices truly abusing PNBs on Medicare patients. The reimbursement just isn’t worth it. The most likely explanation is that the powers that be know interventional pain is overutilized so as a general category it’s on the chopping block, but stim and the other true cost drivers have multiple billion dollar companies lobbying for them. So, cool, I can SCS anyone with refractory trunk and/or limb pain at $30,000 a pop, but god forbid I do therapeutic ONBs on a few patients with C2-7 fusions or occipital headaches for $80. Oh, and even that will get cut in half next year if I do it at the same time as an office visit.

 

[gaschicago]

Convert all nerve blocks into cash procedures?

 

[bedrock]

I’m not aware of any practices truly abusing PNBs on Medicare patients. The reimbursement just isn’t worth it. The most likely explanation is that the powers that be know interventional pain is overutilized so as a general category it’s on the chopping block, but stim and the other true cost drivers have multiple billion dollar companies lobbying for them. So, cool, I can SCS anyone with refractory trunk and/or limb pain at $30,000 a pop, but god forbid I do therapeutic ONBs on a few patients with C2-7 fusions or occipital headaches for $80. Oh, and even that will get cut in half next year if I do it at the same time as an office visit.

I think you nailed that rationale. It’s so ridiculous because the small procedures we do help so many people without exposing them to more serious risks.

 

[bedrock]

Convert all nerve blocks into cash procedures?

Seems like we need to convert half of pain techniques into cash procedures. With the new rules, if someone wants a peripheral joint injection the same day, it will have to be cash only. If they want to stop back later that week we’ll squeeze it in via insurance.

All the PMR docs doing EMGs are also screwed by the new rules. One of the only way that EMGs could pay halfway decently was to add a new patient consult code onto the EMG with 25 modifier. If that gets whacked by 50% it will be impossible to find anyone to do EMGs for patients.

 

[Orin]

I would assume like the SI joint injection, diagnostic doesn't mean without steroids

I would remind y'all that they say you can still do all this for acute pain, so I guess they want us to poke people sooner or maybe this specific pain started 4 weeks into their PT for pain in the region🤔

It's an annoying LCD and will mostly lead to more shoulder/hip surgeries

 

[Laryngospasm]

I’m not aware of any practices truly abusing PNBs on Medicare patients. The reimbursement just isn’t worth it. The most likely explanation is that the powers that be know interventional pain is overutilized so as a general category it’s on the chopping block, but stim and the other true cost drivers have multiple billion dollar companies lobbying for them. So, cool, I can SCS anyone with refractory trunk and/or limb pain at $30,000 a pop, but god forbid I do therapeutic ONBs on a few patients with C2-7 fusions or occipital headaches for $80. Oh, and even that will get cut in half next year if I do it at the same time as an office visit.

Agree.. however slight disagreement as well.. I don’t believe they care or believe so much that pnbs and such are over utilized as much as they see pain as an easy target for cost cutting. No one is doing pnbs to get rich, they are a time suck and underpaid. No I’m not interested in doing a lateral femoral cutaneous nerve block on your patient with a bmi of 45 for 20 or 30$ after taxes.
Kind of hard to deny cardiac stents and stress tests.. pnbs and epidurals not so much. No one will cry about a few slimy pill pushing rich doctors making less money. That’s the stigma unfortunately.