A proposal that would strip Medicare coverage from widely used peripheral nerve block procedures is still active nearly eight months after five Medicare Administrative Contractors published draft local coverage determinations in October.
The proposed LCDs would classify therapeutic peripheral nerve blocks, peripheral nerve denervation and radiofrequency ablation as “not reasonable and necessary” for chronic pain. Physicians and pain medicine societies have warned the move would eliminate access to low-cost, minimally invasive procedures that reduce opioid use, prevent unnecessary surgeries and serve a diagnostic function that more aggressive treatments cannot replicate.
“As our nation continues to recover from the ongoing impacts of the opioid abuse epidemic, non-opioid alternatives are a critical component to ensuring pain management and increased quality of life,” American Society of Anesthesiologists president Patrick Giam, MD, said in a news release. “Anesthesiologists are experts in pain management and we strongly urge CMS to take action to continue access to peripheral nerve blocks and similar procedures.”
The American Medical Association sent a formal letter to CMS Administrator Mehmet Oz, MD, urging the agency to withdraw or delay the proposed LCDs, warning that the policies would restrict patient access to evidence-based, non-opioid pain treatments and force clinicians to rely on less appropriate or higher-risk alternatives.
A resolution opposing the LCDs, submitted by the American Academy of Pain Medicine along with members of the Pain Medicine Coalition, six additional pain societies, and three state societies, was adopted at the AMA House of Delegates’ November 2025 meeting.
In January 2026, leaders from the Pain Medicine Coalition met virtually with MAC representatives to discuss the proposed LCD. During the meeting, physicians presented patient-centered examples illustrating how peripheral nerve blocks are used to manage complex pain conditions, including occipital nerve blocks for severe headache disorders, genicular nerve blocks and radiofrequency ablation for chronic knee pain as an alternative to corticosteroid injections or joint replacement, and stellate ganglion blocks for post-herpetic neuralgia and upper-extremity complex regional pain syndrome.
While CMS and the MACs have not resolved the question, at least one commercial insurer has already moved. Blue Cross NC implemented a genicular nerve block coverage policy in March 2026 that explicitly references the proposed LCDs. For physicians treating chronic pain patients, the move shows that coverage erosion that begins with a Medicare proposal does not stay contained to Medicare.
John Cianca, MD, president of the American Academy of Physical Medicine and Rehabilitation, told Becker’s the proposal narrows treatment options in ways that compound across the care continuum.
“It is about a low-cost, minimally invasive procedure that could prevent surgeries that have a greater risk of complications or outright failure,” Dr. Cianca said. “Physical therapy, which is traditionally used as an initial treatment option, is often difficult to tolerate until pain relief is obtained. So by eliminating access to this type of treatment, the effectiveness, and perhaps even the tolerance of a more conservative option such as physical therapy is also negatively impacted. It also exposes patients to the potential for opioid use and abuse.”
The comment periods closed in late 2025. The MACs have not published final determinations. Physicians and pain societies are treating the continued inaction as neither a victory nor a resolution.