The five Medicare Administrative Contractors that proposed eliminating coverage for nearly all peripheral nerve procedures have posted final LCDs. The notice period opened September 10, 2026. The policies take effect for services performed on or after October 25, 2026.
Who Is Covered by Which Document
| LCD | MAC | States |
|---|---|---|
| L40261 | CGS | KY, OH |
| L40263 | Palmetto | AL, GA, TN, NC, SC, VA, WV |
| L40265 | Noridian | CA, HI, NV, AK, AZ, ID, MT, ND, OR, SD, UT, WA, WY |
| L40267 | Wellpoint Federal | IL, MN, WI, CT, NY, ME, MA, NH, RI, VT |
| L40300 | WPS | IA, KS, MO, NE, IN, MI |
What Came Back
Sympathetic blocks for CRPS: moved from “investigational” to covered, with strict criteria: IASP diagnosis, CRPS Severity Score at baseline, failed standard of care, and ongoing interdisciplinary team care. Repeat blocks require ≥50% relief plus objective sympathetic blockade (Horner’s for stellate; ≥2°C ipsilateral foot rise or ≥1.5°C interfoot gradient at 20 minutes for lumbar). Past 5 lifetime blocks, document a sustained 5-point CSS drop lasting ≥3 months.
Genicular procedures: — diagnostic injection covered with KL grade 3–4, ≥3 months pain, failed conservative care, low injectate volume (0.3–0.5 mL), no IAI or knee surgery within 3 months. Maximum 2 diagnostic sessions per knee. Ablation follows ≥50% relief sustained ≥3 months in a patient who is a poor surgical candidate or declines surgery. Maximum 2 RFA sessions per knee per rolling 12 months (23 months relief may be unrealistic).
Lifetime caps removed for median nerve (now 3 per nerve, ≥2 months apart) and Morton’s neuroma.
What Did Not
Ganglion impar block and denervation. Therapeutic genicular injection. Genicular ablation after total knee replacement. Pudendal nerve blocks. Intercostal nerve blocks. (Never listed under consideration).
Read sections F–L of your own jurisdiction’s LCD for occipital, suprascapular, pudendal, posterior tibial, and thoracic before assuming their status.
Two Things That Will Cause Denials in Otherwise Compliant Practices
Sedation. Moderate/deep sedation, GA, and MAC are declared “rarely indicated” for nerve injections and not reasonable and necessary. The LCD names needle phobia specifically and says oral anxiolytics typically suffice. Exceptions require patient-specific documentation — a standing protocol will not survive review.
Image guidance. Ultrasound covered only where needed for nerve identification; fluoroscopy only for covered RFA. Guidance performed for a non-covered injection is itself non-covered — the denial takes both codes.
Four Things to Do Before October 25
- Pull your jurisdiction’s Billing and Coding Article. The CPT/ICD-10 detail lives there and drives the claim edits — not in the LCD.
- Rebuild CRPS and genicular templates around the named criteria. Note the trap: the same pain scale must be used at baseline and after each diagnostic procedure.
- Audit sedation documentation if MAC is routine for your nerve injections.
- Build the ABN workflow now for services becoming patient responsibility.