Three Jurisdictions Sat Out the New Nerve Block Policy
Five Medicare contractors now run one rewritten chronic pain nerve injection policy across nine of the twelve A/B MAC jurisdictions, and the longest of the predecessor covered-code lists drops from 31 codes to 14. Novitas and First Coast never adopted it, and $40.0 million of the dropped codes sits in their jurisdictions.
A patient in Memphis and a patient in West Memphis, Arkansas, four miles apart across the river, get the same peripheral nerve injection on 64450, billed to the same Medicare program.
The Memphis claim now hits a covered-code list that 64450 is not on. The West Memphis claim doesn't, because the line that matters there is the one between Palmetto GBA and Novitas Solutions.
Five Medicare contractors went live in the last nine days with a single rewritten policy, "Peripheral Nerve Injections and Procedures for Chronic Pain." It covers nine of the twelve A/B MAC jurisdictions, 38 states and three Pacific territories. Every edition carries the same 14-code covered list, and the policy says what happens to everything else in one sentence that appears, word for word, in all five:
"A therapeutic PNI or denervation not listed as covered in the LCD is non-covered."
That is as close to a national coverage determination as the contractor system produces without CMS writing one. So where is the other quarter of the country?
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