In a major win for patient-centered chronic pain care, the American Medical Association (AMA) House of Delegates has adopted ASRA Pain Medicine’s resolution opposing proposed Medicare cuts to peripheral nerve block (PNB) coverage. ASRA Pain Medicine AMA delegates Richard Chou, MD, MBA, FACHE, CPE, and Lee Tian, MD, authored the resolution, which garnered support and co-authorship from several pain medicine societies.

The resolution directs the AMA to oppose Local Coverage Determinations (LCDs) issued by five Medical Administrative Contractors (MACs) that would eliminate coverage for well-established peripheral nerve block (PNB) and denervation procedures. These draft LCDs deem many of these procedures for chronic pain as “not reasonable and necessary.” The procedures include genicular, suprascapular, pudendal, occipital, trigeminal stellate ganglion, and thoracic interventions. Under the proposals, Medicare coverage would be pared down to a small subset of procedures, significantly disrupting access to evidence-based, multidisciplinary, and non-opioid pain treatment options.

“These procedures are essential components of multidisciplinary care for millions of Americans who live with chronic pain on a daily basis.”

The AMA resolution was submitted on behalf of the ASRA Pain Medicine, the American Society of Anesthesiologists, and other members of the Pain Medicine Coalition, including the International Pain & Spine Intervention Society and the American Academy of Physical Medicine and Rehabilitation. Additional coauthors are the American Academy of Pain Medicine, the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, the American Society of Interventional Pain Physicians, the North American Neuromodulation Society, the North American Spine Society, the California Medical Association, Washington State Medical Association, and the Montana Medical Society.

The resolution further reaffirms existing AMA policy supporting the full spectrum of multimodal pain care and directs the AMA to advocate with the Centers for Medicare & Medicaid Services (CMS) and MACs to preserve and, where appropriate, expand coverage for peripheral nerve blockade as part of comprehensive, guideline-aligned pain management.

“This is a critical win for patients living with chronic pain and for the clinicians who care for them,” said Steven P. Cohen, MD, ASRA Pain Medicine president. “The proposed LCDs would sharply restrict access to procedures that are supported by evidence, widely used in practice, and often essential to helping patients avoid or reduce opioid use.”

Peripheral nerve blocks play an important therapeutic, diagnostic, and prognostic role in pain management. In addition to providing targeted, localized analgesia that can reduce reliance on systemic opioids, PNBs guide appropriate escalation to radiofrequency ablation, peripheral nerve stimulation, spinal cord stimulation, and surgical interventions. Many of these pathways depend on a valid diagnostic block. For some procedures threatened by the proposed LCDs, such as occipital neuralgia and some forms of complex regional pain syndrome, a correct diagnosis depends on a valid diagnostic block.

“We are grateful that the AMA recognizes the seriousness of this issue and has joined ASRA Pain Medicine in calling for the withdrawal of these policies,” Cohen said. “These procedures are essential components of multidisciplinary care for millions of Americans who live with chronic pain on a daily basis.”

Federal guidance, including the CDC Clinical Practice Guideline for Prescribing Opioids for Pain (2022) and the Pain Management Best Practices Inter-Agency Task Force Report (2022), emphasizes prioritizing non-opioid and multimodal approaches. Removing coverage for these procedures would undermine safer, evidence-based pain care and reverse progress toward national goals for reducing unnecessary opioid exposure.

With the resolution’s adoption, ASRA Pain Medicine will continue to lead efforts, together with the AMA, the Pain Medicine Coalition, and its partner societies, to ensure that Medicare coverage policies reflect clinical evidence, patient need, and the principles of comprehensive, patient-centered pain management.

More information on proposed LCDs is found at the ASRA Pain Medicine Advocacy Center.