CMS Faces Pressure to Withdraw Proposed Changes to Peripheral Nerve Block Coverage

The American Medical Association (AMA) and the American Society of Anesthesiologists (ASA) are urging the Centers for Medicare & Medicaid Services (CMS) to withdraw proposed Local Coverage Determinations (LCDs) that could significantly restrict Medicare coverage for peripheral nerve blocks (PNBs) used to treat chronic pain. These proposed changes, initially put forth by five Medicare Administrative Contractors (MACs), have sparked concern among pain management specialists and patient advocacy groups who fear the policies will limit access to effective, non-opioid pain treatments.

Concerns Over Restricting Non-Opioid Pain Management

The proposed LCDs would label PNBs and other chronic pain procedures as “experimental” or “investigational,” potentially eliminating coverage for these well-established interventions. The AMA, in a letter to CMS Administrator Mehmet C. Oz, MD, MBA, warned that such restrictions could force clinicians to rely on less appropriate or higher-risk alternatives, potentially increasing opioid use among Medicare beneficiaries. Source

ASA echoed these concerns, applauding 25 bipartisan members of Congress for signing a letter to CMS opposing the changes. The lawmakers emphasized that limiting access to non-opioid alternatives like PNBs could exacerbate the opioid crisis. Source

What are Peripheral Nerve Blocks?

A peripheral nerve block is a form of regional anesthesia that inhibits impulse transmission in a nerve, effectively blocking pain signals. Source These blocks are widely used to manage chronic pain conditions, offering a less invasive alternative to opioid-based pain management.

Advocacy Efforts and Coalition Support

ASA has been actively working with the Pain Medicine Coalition and other pain societies to advocate for continued coverage of PNBs. Physician leaders and coalition staff have engaged with Medicare contractors and submitted written comments highlighting the clinical evidence supporting the effectiveness of these procedures.

Navigating Medicare Coverage Information

For providers seeking information on billing and coding related to peripheral nerve blocks, the Medicare Administrative Contractor (MAC) is the primary point of contact. Information regarding specific codes (CPT/HCPCS, ICD-10) can be found in Billing & Coding Articles, accessible through the Medicare Coverage Database (MCD) Search. Source Beneficiaries with questions about their coverage can call 1-800-Medicare or visit Medicare.gov. Source

Looking Ahead

The outcome of these discussions will have significant implications for patients with chronic pain and the broader effort to reduce reliance on opioid medications. The AMA and ASA remain committed to ensuring that Medicare beneficiaries have access to evidence-based, non-opioid pain management options, including peripheral nerve blocks.