ASA Strongly Opposes Ill-Conceived Peripheral Nerve Blocks LCD

ASA has launched a new initiative opposing multiple Medicare Administrative Contractors’ (MACs) proposed Local Carrier Determinations (LCDs) addressing Peripheral Nerve Blocks and Procedures for Chronic Pain.  The LCDs would restrict coverage for many evidence-based procedures used in chronic pain management, potentially increasing reliance on opioids. ASA’s Committee on Pain Medicine (COPM) is working in conjunction with ASA’s Contractor Advisory Sub-Committee of the Committee on Economics to organize a response. 

Among the proposed changes, the MACs are proposing to deem genicular nerve blocks/ablation, as well as other peripheral nerve blocks and ablations, as “not reasonable and necessary.”  As a result, the proposed LCDs would deny patients with debilitating pain access to safe and effective treatments that are supported by guidelines and real-world evidence.

ASA has coordinated ASA member pain physicians to attend and personally testify to the value of these procedures at the Open Meetings held by the 5 involved MACs – CGS Administrators, National Government Services, Noridian Healthcare Solutions, Palmetto GBA, and WPS Government Health Administrators. Many of these physicians have been able to share patient success stories. 

Of note, the Medicare contractor Novitas (covering New York, New Jersey, Pennsylvania, Maryland and Delaware) is the only Medicare contractor to decline to propose these draft policies.

ASA will be submitting formal comments to the MACs that present strong scientific evidence and patient anecdotal evidence that supports coverage of peripheral nerve blocks (PNBs), as well as highlights them as a safe and evidence-based non-opioid treatment option and focuses on their track record of safety.

ASA is seeking all avenues of advocacy related to this highly concerning move by the MACs. Efforts are being coordinated with other pain societies and the Multi-Society Pain Workgroup.

We are encouraging our members to submit comments to the MACs, including any patient success stories and anectodical evidence that highlights the effectiveness of PNBs. The deadline to submit comments is Friday, November 8.