ACEP is concerned by the recent attempts by the majority of Medicare Administrative Contractors (MACs) to limit coverage for peripheral nerve blocks (PNB) when used to treat chronic pain. The proposed Local Coverage Determinations (LCDs) would restrict reimbursement for PNBs for chronic conditions 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). You can view your MAC’s proposed LCD for PNBs for Chronic Pain via the Medicare Coverage Database. As of March 16, 2026, Novitas is the only MAC that has not issued any proposed changes to its PNBs for Chronic Pain coverage indications.
The American Medical Association and ASRA Pain Medicine have urged the Centers for Medicare and Medicaid Services to direct the MACs to withdraw or delay the proposed Local Coverage Determinations (LCDs). There is also bipartisan Congressional support to rescind the proposed LCDs, with Representatives Brittany Pettersen (D-CO-7) and Claudia Tenney (R-NY-24) leading a "Dear Colleague" letter urging CMS to reverse these harmful policies.
It is important to note that coverage for PNBs that are considered bundled into other procedures, or for indications other than chronic pain, would not be impacted by the proposed PNBs for Chronic Pain LCDs, as the LCDs specifically exempt PNBs used for a) regional anesthetic blocks; b) acute surgical pain; and, 3) Pain related to malignancy refractory to medical management.
Nonetheless, ACEP is greatly concerned by the MACs decision to limit Medicare beneficiaries’ access to treatment deemed appropriate by the House of Medicine. It is our hope that the MACs will listen to the feedback of the medical experts and opt not to finalize the proposed LCDs.
