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Date Printed: October 23, 2017: 07:19 AM

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This medical policy (medical coverage guideline) is Copyright 2017, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association. The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

02-61000-29

Original Effective Date: 11/15/00

Reviewed: 10/23/14

Revised: 11/17/16

Subject: Nerve Block Injections

THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION.

           
Position Statement Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines
           
Other References Updates    
           

DESCRIPTION:

Nerve blocks consist of injection of a local anesthetic, with or without a steroid, into a peripheral nerve or a nerve ganglion, in an attempt to block pain signals and provide prolonged relief from pain.

Peripheral nerve blocks can be administered in a medical office or pain clinic setting. Sympathetic ganglion and nerve root injections are often performed under fluoroscopic x-ray guidance.

POSITION STATEMENT:

 

Certificate of Medical Necessity

Submit a completed Certificate of Medical Necessity (CMN) along with your request to expedite the medical review process.

1. Click the link Nerve Block Injections - Certificate of Medical Necessity (MS Word) to open the form.

2. Complete all fields on the form thoroughly.

3. Print and submit a copy of the form with your request.

Note: Florida Blue regularly updates CMNs. Ensure you are using the most current copy of a CMN before submitting to Florida Blue. For a complete list of available CMNs, visit the Certificates of Medical Necessity page.

Sympathetic nerve block injections meet the definition of medical necessity for the following indications:

Complex regional pain syndrome (CRPS):

Ischemic limb pain:

Pancreatic cancer:

Chronic pancreatitis:

Pelvic/perineal pain:

Ganglion impar blocks of the sacrococcygeal joint are considered experimental or investigational. The available scientific evidence remains insufficient to permit conclusions concerning the effect of this procedure on net health outcomes.

Occipital neuralgia and headache:

Sphenopalatine nerve blocks for the treatment of any condition, including but not limited to occipital neuralgia and headache are considered experimental or investigational. The available scientific evidence remains insufficient to permit conclusions concerning the effect of this procedure on net health outcomes.

Peripheral nerve block injections meet the definition of medical necessity for the following indications:

Morton’s neuroma:

Plantar fasciitis and other neuritis of the foot:

Medical necessity for imaging (fluoroscopic or ultrasound) for nerve block injections to the foot has not been established.

Occipital neuralgia:

Peripheral nerve block of any occipital or cranial nerve for the treatment of occipital neuralgia, headache, neck pain or other pain is considered experimental or investigational. The available scientific evidence remains insufficient to permit conclusions concerning the effect of this procedure on net health outcomes.

Diabetic neuropathy:

Peripheral nerve block of any nerve for the treatment of diabetic neuropathy is considered experimental or investigational. The available scientific evidence remains insufficient to permit conclusions concerning the effect of this procedure on net health outcomes.

All other peripheral nerve blocks:

NOTE: PT, OT or home exercise programs would be continued in addition to nerve block injections as part of a combined treatment plan. It is not expected that epidural blocks, multiple facet joint injections, sacroiliac joint injections, and sympathetic nerve blocks in any and all combinations would be administered to the same individual on the same day. If the first procedure used to treat the presumptive diagnosis fails to produce improvement and rules out that possibility, then it may be appropriate to proceed to the next logical treatment.

Nerve block injections do not meet the definition of medical necessity when medical documentation indicates the injection procedures are not effective.

BILLING/CODING INFORMATION:

CPT Coding:

64400

Injection, anesthetic agent; trigeminal nerve, any division or branch

64402

Facial nerve

64405

Injection, anesthetic agent; greater occipital nerve (investigational)

64408

Vagus nerve

64410

Phrenic nerve

64413

Cervical plexus

64415

Brachial plexus, single

64416

Brachial plexus, continuous infusion by catheter (including catheter placement)

64417

Axillary nerve

64418

Suprascapular nerve

64420

Intercostal nerve, single

64421

Intercostal nerve, multiple, regional block

64425

Ilioinguinal, iliohypogastric nerves

64430

Pudendal nerve

64435

Paracervical (uterine) nerve

64445

Sciatic nerve, single

64446

Sciatic nerve, continuous infusion by catheter

64447

Femoral nerve, single

64448

Femoral nerve, continuous infusion by catheter

64449

Lumbar plexus, posterior approach, continuous infusion by catheter

64450

Other peripheral nerve or branch

64455

Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s), e.g., Morton’s neuroma.

64461

Paravertebral block (PVB) (paravertebral block), thoracic single injection site (including imaging guidance, when performed)

64462

Paravertebral block (PVB) (paravertebral block), second and any additional injection site(s) (including imaging guidance, when performed)(List separately in addition to code for primary procedure)

64505

Injection, anesthetic agent; sphenopalatine ganglion (investigational)

64510

Injection, anesthetic agent; stellate ganglion (cervical sympathetic)

64517

Injection, anesthetic agent; superior hypogastric plexus

64520

Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)

64530

Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring

ICD-10 Diagnoses Codes That Support Medical Necessity: (Effective 10/01/15)

G57.60 – G57.62

Lesion of plantar nerve

G89.11

Acute pain due to trauma

G89.12

Acute post-thoracotomy pain

G89.18

Other acute postprocedural pain

M25.511 – M25.519

Pain in shoulder

M25.521 – M25.529

Pain in elbow

M25.531 – M25.539

Pain in wrist

M25.541, M25.542, M25.549

Pain in joints of hand

M25.551 – M25.559

Pain in hip

M25.561 – M25.569

Pain in knee

M25.571 – M25.579

Pain in ankle

M25.751 – M25.759

Osteophyte, hip

M54.10 – M54.18

Radiculopathy

M54.2

Cervicalgia

M54.5

Low back pain

M54.6

Pain in thoracic spine

M70.60 – M70.62

Trochanteric bursitis, hip

M70.70 – M70.72

Other bursitis of hip

M72.2

Plantar fascial fibromatosis

M75.00 – M75.02

Adhesive capsulitis of shoulder

M76.01 – M76.32

Psoas tendinitis; Iliac crest spur; Iliotibial band syndrome

M79.2

Neuralgia and neuritis, unspecified

M79.621 – M79.622

Pain in upper arm

M79.631 – M79.632

Pain in forearm

M79.641 – M79.646

Pain in hand and fingers

M79.661 – M79.662

Pain in lower leg

M79.671, 672 – M79.674, 675

Pain in foot and toes

N94.89 – N94.9

Other specified conditions associated with female genital organs and menstrual cycle

Q85.00 – Q85.09

Neurofibromatosis or schwannomatosis

R07.1

Chest pain on breathing

R07.81

Pleurodynia

R10.0 – R10.33

Abdominal and pelvic pain

R19.8

Other and unspecified symptoms and signs involving the digestive system and abdomen

T87.30 – T87.34

Neuroma of amputation stump

REIMBURSEMENT INFORMATION:

**64400-64402: Total number of injections is limited to four (4) injections in six (6) months.

**64408-64462: Total number of injections is limited to four (4) injections in six (6) months.

**64450: Total number of injections is limited to four (4) injections in six (6) months.

**64510-64530: Total number of injections, in any combination, is limited to three (3) injections in twelve (12) months.

**64455: Total number of injections, in any combination, is limited to three (3) injections in twelve (12) months, per neuroma.

Coding notes:

Per CPT guidelines:

**NOTE: Services in excess of the limitations shown above are subject to medical review of documentation for determination of medical necessity. The following information may be required documentation to support medical necessity: physician history and physical, physician progress notes including documentation of conservative treatment, treatment plan, radiology study reports, and operative report.

LOINC Codes:

Documentation Table

LOINC Codes

LOINC Time Frame Modifier Code

LOINC Time Frame Modifier Codes Narrative

Physician history and physical

28626-0

18805-2

Include all data of the selected type that represents observations made six months or fewer before starting date of service for the claim.

Attending physician visit note

18733-6

18805-2

Include all data of the selected type that represents observations made six months or fewer before starting date of service for the claim.

Treatment plan

18776-5

18805-2

Include all data of the selected type that represents observations made six months or fewer before starting date of service for the claim.

Radiology report

18726-0

18805-2

Include all data of the selected type that represents observations made six months or fewer before starting date of service for the claim.

Surgical report

28573-4

18805-2

Include all data of the selected type that represents observations made six months or fewer before starting date of service for the claim.

PROGRAM EXCEPTIONS:

Federal Employee Program (FEP): Follow FEP guidelines.

State Account Organization (SAO): Follow SAO guidelines.

Medicare Advantage: The following Local Coverage Determinations (LCD) were reviewed on the last guideline reviewed date: Peripheral Nerve Blocks (L33933) and Destruction by neurolytic agent; interdigital nerve of the foot—Morton’s Neuroma (L33812), located at fcso.com.

DEFINITIONS:

Cervical plexus: a network of nerves made up of the C1, C2, C3, and C4 spinal nerves; innervates the skin and muscles of the head, neck, and shoulders. A nerve block can be performed with a single injection at the C4 transverse process with the local anesthetic spreading to the C2 and C3 nerves.

Morton’s neuroma: a swelling of the nerve present in the space between the third and fourth toes.

Nerve blocks: injection(s) near specific nerves (i.e., certain spinal, peripheral, or other nerves).

Neuritis: Inflammation of a nerve.

Peripheral nerve: any nerve outside the central nervous system.

Plantar fasciitis: inflammation of the band of tissue that connects the heel bone to the toes.

Sphenopalatine ganglion: located in a fossa behind the middle turbinate at the root of the nose and consists of somatosensory, sympathetic, and parasympathetic fibers.

Stellate ganglion: collection of sympathetic nerves in the upper neck on either side of the larynx and is the nerve center for the hand, arms, and shoulders.

Sympathetic nerve: a nerve of the sympathetic nervous system which is part of the autonomic nervous system that is concerned especially with preparing the body to react to situations of stress or emergency, that contains chiefly adrenergic fibers and tends to depress secretion, decrease the tone and contractility of smooth muscle, increase heart rate, and that consists essentially of preganglionic fibers arising in the thoracic and upper lumbar parts of the spinal cord and passing through delicate white rami communicates to ganglia located in a pair of sympathetic chains situated one on each side of the spinal column or to more peripheral ganglia or ganglionated plexuses and postganglionic fibers passing typically through gray rami communicates to spinal nerves with which they are distributed to various end organs.

RELATED GUIDELINES:

Neurolysis, 02-61000-34

OTHER:

None applicable.

REFERENCES:

  1. American Academy of Family Physicians. Plantar Fasciitis: A Common Cause of Heel Pain. ©2000 – 2010.
  2. American Cancer Society Treatment & Topics Resources. Pain Control: A Guide for People with Cancer and Their Families. Updated 11/04/08. (accessed 04/06/09).
  3. American Chronic Pain Association. ACPA Consumer Guide to Pain Medication & Treatment 2009. Epidurals, Nerve & Facet Blocks & Radiofrequency Ablation (Rhizotomy). (accessed on 04/03/09).
  4. American Podiatric Medical Association. Treatment by Your Podiatric Physician: Neuromas. ©2010 American Podiatric Medical Association, Inc.
  5. American Podiatric Medical Association. Treatment by Your Podiatric Physician: Heel Pain. ©2010 American Podiatric Medical Association, Inc.
  6. Ashkenazi A, Blumenfeld A et al. Peripheral Nerve Blocks and Trigger Point Injections in Headache Management – A Systematic Review and Suggestions for Future Research. Headache 2010;50:943-952.
  7. Baron R, Binder A, Wasner G. (2010). Neuropathic pain: diagnosis, pathophysiological mechanisms, and treatment. The Lancet Neurology, 9(8), 807-819.
  8. Blue Cross Blue Shield Association Medical Policy Reference Manual. 2.01.85, Neural Therapy. December 2013.
  9. Blue Cross Blue Shield of Florida physician consultant, (10/29/03, 11/30/07).
  10. Boswell MV, Shah RV, Everett CR, Sehgal N, Mckenzie-Brown AM, Abdi S, Bowman RC, Deer TR, Datta S, Colson JD, Spillane WF, Smith HS, Lucas LF, Burton AW, Chopra P, Staats PS, Wasserman RA, Manchikanti L. Interventional techniques in the management of chronic spinal pain: evidence-based practice guidelines. Pain Phys 2005;8(1): 1-47.
  11. Callaghan BC, Cheng HT, Stables CL, Smith AL, Feldman EL. (2012). Diabetic neuropathy: clinical manifestations and current treatments. The Lancet Neurology, 11(6), 521-534.
  12. Cepeda MS, Carr DB, Lau J. Local anesthetic sympathetic blockade for complex regional pain syndrome. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004598. DOI: 10.1002/14651858. CD004598.pub2.
  13. Cho DY, Drover DR, Nekhendzy V, Butwick AJ, Collins J, Hwang PH. The effectiveness of preemptive sphenopalatine ganglion block on postoperative pain and functional outcomes after functional endoscopic sinus surgery. Int Forum Allergy Rhinol. 2011 May-Jun;1(3):212-8.
  14. Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2; 147(7): 478-91.
  15. ClinicalTrials.gov. Botox Injection in Treatment of Cluster Headache, NCT02019017. Last updated January 3, 2014.
  16. ClinicalTrials.gov. Sphenopalatine Nerve Block for Headache TX 360, NCT01939314. Last updated September 5, 2013.
  17. Cuvillon P, Reubrecht V, Zoric L, Lemoine L, Belin M, Ducombs O, Birenbaum A, Riou B, Langeron O. Comparison of subgluteal sciatic nerve block duration in type 2 diabetic and non-diabetic patients. Br J Anaesth. 2013 May;110(5):823-30.
  18. DeMaria S Jr, Govindaraj S, Chinosorvatana N, Kang S, Levine A. Bilateral sphenopalatine ganglion blockade improves postoperative analgesia after endoscopic sinus surgery. Am J Rhinol Allergy. 2012 Jan-Feb;26(1):e23-7.
  19. Dworkin RH, et al. (2013). Interventional management of neuropathic pain: NeuPSIG recommendations. PAIN®, 154(11), 2249-2261.
  20. Everett C R, Shah R V, Sehgal N, McKenzie-Brown A M. A systematic review of diagnostic utility of selective nerve root blocks. Pain Physician. 2005;8(2): 225-233.
  21. First Coast Service Options (FCSO). Florida Medicare Part B Local Coverage Determination. L29258 Peripheral Nerve Blocks 02/02/09. (Revised 03/17/14)
  22. Hashimoto A, Ito H, Sato Y, Fujiwara Y. (2013). The Efficacy and Safety of Continuous Popliteal Sciatic Nerve Block for the Relief of Pain Associated with Critical Limb Ischemia: A Retrospective Study. Open Journal of Anesthesiology, 3, 433.
  23. Hayes Inc. Hayes Medical Technology Directory. Nerve Blocks for the Treatment of Chronic Nonmalignant Pain. Lansdale, PA: Hayes, Inc.; December 2005. Update performed 12/15/06.
  24. Health Care Guideline: Assessment and Management of Chronic Pain. INSTITUTE FOR CLINICAL SYSTEMS IMPROVEMENT. 2009.
  25. Institute for Clinical Systems Improvement (ICSI). Assessment and management of acute pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Mar. 68 p.
  26. InterQual® 2010. Adult Procedures. Neuroablation, percutaneous.
  27. InterQual® 2011. Adult Procedures. Sympathetic Blockade, Percutaneous.
  28. Lin CS, MD, Cheng JK et al. Ultrasound-Guided Ganglion Impar Block: A Technical Report. Pain Medicine 2010; 11: 390–394.
  29. Mailis A, Taenzer P. (2012). Evidence-based guideline for neuropathic pain interventional treatments: Spinal cord stimulation, intravenous infusions, epidural injections and nerve blocks. Pain Research & Management: The Journal of the Canadian Pain Society, 17(3), 150.
  30. Manchikanti L, Staats PS, Singh V, Schultz DM, Vilims BD, Jasper JF, Kloth DS, Trescot AM, Hansen HC, Falasca TD, Racz GB, Deer TR, Burton AW, Helm S, Lou L, Bakhit CE, Dunbar EE, Atluri SL, Calodney AK, et al. Evidence-based practice guidelines for interventional techniques in the management of chronic spinal pain. Pain Phys 2003; 6: 3-81.
  31. Manchikanti, L., Singh, V., Kloth, D. Interventional Pain Management Practice Policies; Sympathetic Blocks. American Society of Interventional Pain Physicians. Accessed 04/09/09.
  32. National Institute for Health and Clinical Excellence (NICE). Clinical Guideline 150: Headaches: Diagnosis and management of headaches in young people and adults. September 2012.
  33. National Institute of Neurological Disorders and Stroke. Complex Regional Pain Syndrome Fact Sheet; last updated 02/03/09. (accessed 04/06/09).
  34. National Podiatric Medical Association. Foot Health Topics. Neuromas. ©2008 National Podiatric Medical Association.
  35. Parker MJ, Griffiths R, Appadu BN. Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Cochrane Database of Systematic Reviews 2002, Issue 1. Art. No.: CD001159. DOI: 10.1002/14651858. CD001159.
  36. Patijn J, Janssen M. et al. Coccygodynia. Pain Practice, Volume 10, Issue 6, 2010 554–559.
  37. Perez RS, Zollinger PE, Dijkstra PU, Thomassen-Hilgersom IL, Zuurmond WW, Rosenbrand KCJ, Geertzen JH. Evidence based guidelines for complex regional pain syndrome type 1. BMC Neurology 2010, 10:20.
  38. Practice Guidelines for Chronic Pain Management. An Updated Report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2010; 112:1–1.
  39. Rodman R, Dutton J. Endoscopic neural blockade for rhinogenic headache and facial pain: 2011 update. Int Forum Allergy Rhinol. 2012 Jul-Aug;2(4):325-30.
  40. Sahai-Srivastava S, Subhani D. Adverse effect profile of Lidocaine injections for occipital nerve block in occipital neuralgia. J Headache Pain (2010) 11:519–523.
  41. Schytz HW, Barløse M, Guo S, Selb J, Caparso A, Jensen R, Ashina M. Experimental activation of the sphenopalatine ganglion provokes cluster-like attacks in humans. Cephalalgia 0(0) 1–11. ©International Headache Society 2013.
  42. Spine-health.com website – Selective nerve root block (SNRB).
  43. Spineuniverse.com website – Nerve Blocks: Part II and I.
  44. Spineuniverse.com website – Selective Nerve Root Blocks.
  45. Tepper SJ, Stillman MJ (2013). Cluster Headache: Potential Options for Medically Refractory Patients (When All Else Fails). Headache Currents, © 2013 American Headache Society.
  46. Thavaneswaran P. Paravertebral blocks for anaesthesia and analgesia: a systematic review. Stepney, SA: Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S). 2006:268. Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S).
  47. Tobin J, Flitman S. Treatment of Migraine With Occipital Nerve Blocks Using Only Corticosteroids. Headache 2011;51:155-162.
  48. Toshniwal GR, Dureja GP, Prashanth SM. Transsacrococcygeal Approach to Ganglion Impar Block for Management Of Chronic Perineal Pain: A Prospective Observational Study. Pain Physician 2007; 10:661-666.
  49. Weiner, R. (2002). Pain Management A Practical Guide for Clinicians (6th ed). Boca Raton. CRC Press.
  50. Yang IY, Oraee S. A Novel Approach to Transnasal Sphenopalatine Ganglion Injection. Pain Physician 2006;9:131-134, ISSN 1533-3159.
  51. Zarembinski C, Graff-Radford S. An Unusual Challenge in Performing Sphenopalatine Ganglion Block with Enlarged Coronoid Process: Jacob's Disease. Pain Med. 2014 Feb;15(2):329-32.

COMMITTEE APPROVAL:

This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 10/23/14.

GUIDELINE UPDATE INFORMATION:

11/15/00

Outpatient Pain Management MCG #02-61000-01 approved by MPCC.

12/15/03

Separate MCG created for Nerve Block Injections.

01/01/04

Annual HCPCS coding update.

01/01/06

Scheduled review and revision of guideline consisting of updated references.

11/15/07

Review and revision of guideline consisting of updated references and addition of diagnosis codes.

01/01/09

Annual HCPCS coding update: revised descriptor for codes 64416, 64446, 64448 and 64449.

05/15/09

Scheduled review; update description section to include medical necessity management statement, update position statement to include coverage criteria, update reimbursement statement and references.

11/15/10

Revision; added coverage criteria for peripheral nerve block injections for conditions of the foot; added CPT code 64455; added ICD-9 codes 355.5, 355.79 and 728.71; added related ICD-10 codes; revised reimbursement section; added coding notes; updated definitions section; updated references; reformatted guideline.

07/15/11

Revision; formatting changes.

08/15/11

Scheduled review; revised description, added coverage criteria for pre-emptive analgesia to position statement, revised ICD9 and ICD10 coding sections; added Medicare program exception; updated references; reformatted guideline.

02/15/12

Revision. Added coverage statement for CPT 64405, occipital nerve blocks (E/I). Added coverage statement for ganglion impar blocks of the sacrococcygeal joint (E/I). Added criteria for ”other peripheral nerve blocks”. Updated references and reformatted guideline. Deleted CPT code 64405. Deleted ICD9 codes 307.81, 564.6, 569.42 and 784.0; deleted ICD10 codes G44.00—G44.89, G44.201-G44.229, K59.4, K62.81-K62.82 and R51.

04/01/12

Revision; updated ICD10 coding with new and revised codes.

06/01/12

Revision; added CPT code 64405 back to the guideline with an investigational tag (designated as investigational on 02/15/12). Revised Position Statement verbiage regarding greater occipital nerve blocks. Revised Reimbursement Information section.

04/15/14

Revision; revised description statement and position statement (designated sphenopalantine ganglion block as E/I). Updated program exceptions section and references. Reformatted guideline.

11/15/14

Revision; added coverage statement for nerve block injections for the treatment of diabetic neuropathy (E/I). Reformatted guideline.

10/01/15

Revision; updated ICD9 and ICD10 coding sections.

11/01/15

Revision: ICD-9 Codes deleted.

01/01/16

Annual CPT/HCPCS coding update. Added codes 64461, 64462. Deleted code 64412. Revised Reimbursement Information section and Programs Exception section.

03/01/16

Revision: Update to Position Statement and ICD-10 codes.

10/01/16

ICD-10 coding update: added codes M25.541, M25.542, M25.549.

11/17/16

Revision: Update to Reimbursement Information section

Date Printed: October 23, 2017: 07:19 AM