Several Medicare Administrative Contractors (MACs) have issued proposed Local Coverage Determinations (LCDs) that would dramatically restrict Medicare coverage for peripheral nerve blocks and related procedures used to treat chronic pain

Under the proposed policies, coverage would be limited to radiofrequency neurolysis for trigeminal neuralgia, corticosteroid injections for median neuropathy at the wrist (up to three injections), and corticosteroid injections for Morton’s neuroma (up to two injections). All other peripheral nerve block and denervation procedures—including occipital, stellate ganglion, suprascapular, genicular, pudendal, and posterior tibial nerve interventions—would be deemed noncovered services.

ASRA Pain Medicine believes these proposals misclassify many evidence-based procedures as not medically necessary, which could significantly limit access to effective pain management for patients nationwide.

Clinicians, researchers, and professional societies are strongly encouraged to review the proposed LCDs and submit comments to their respective MACs before the deadlines. Public participation is essential to ensure that coverage determinations reflect clinical evidence and patient need

How to Comment

Submit comments directly through your MAC before the deadlines below:

• CGS Proposed LCD (DL40261) – comments due November 8, 2025
• NGS Proposed LCD (DL40267) – comments due November 8, 2025
• Noridian Proposed LCD (DL40265) – comments due November 8, 2025
• Palmetto Proposed LCD (DL40263) – comments due November 8, 2025
• WPS Proposed LCD (DL40300) – comments due November 22, 2025

Several MACs will also host public meetings in late October. Pain medicine professionals are encouraged to register and share their clinical experience and perspective.

ASRA Pain Medicine will continue to advocate for appropriate coverage policies that align with best evidence and patient-centered care.