Local Coverage Determinations for Peripheral Nerve Injections and Procedures for Chronic Pain: Policy Changes, Clinical Limitations, and Health-Equity Implications.

Five Medicare Administrative Contractors (MACs)-CGS, Palmetto GBA, Wellpoint Federal (formerly National Government Services), Wisconsin Physicians Service, and Noridian-participated in a collaborative policy-development process addressing peripheral nerve injections and related procedures for chronic pain. Novitas Solutions and First Coast Service Options did not participate. The September 2025 draft policies would have limited coverage principally to radiofrequency neurolysis for trigeminal neuralgia and corticosteroid injections for carpal tunnel syndrome and Morton neuroma, with lifetime caps on the latter procedures. After public comment and further evidence review, four contractors published materially identical final LCDs, with a notice period from September 10 through October 24, 2026, and an effective date of October 25, 2026. The final policies restored limited, criteria-based coverage for sympathetic blocks in complex regional pain syndrome, genicular nerve blocks and ablation for selected patients with knee osteoarthritis, greater occipital nerve blocks for occipital neuralgia, and selected suprascapular nerve blocks. They also removed the lifetime caps on median-nerve and Morton-neuroma injections. Pudendal, intercostal, ganglion impar, ulnar, and unspecified other peripheral-nerve procedures remain noncovered when performed for chronic pain. This health-policy analysis compares the draft and final policies, distinguishes Noridian's participation in the collaborative process from publication of a final LCD, summarizes coding and documentation requirements, and examines the access and health-equity implications of geographically discordant Medicare coverage.