APMA Mobilizes Nationwide Response to Proposed LCDs on Peripheral Nerve Blocks

Five of seven Medicare Administrative Contractors (MACs) have proposed Local Coverage Determinations (LCDs) that would restrict coverage for peripheral nerve blocks (PNBs). APMA has coordinated a national response to protect access to these essential services. Impacted MACs include CGS, NGS, Noridian, Palmetto, and WPS. First Coast Service Operations and Novitas have not released a draft LCD.

The proposed draft policy (identical across impacted MACs) would limit coverage for PNBs to only three conditions: trigeminal neuralgia, carpal tunnel syndrome, and Morton's neuroma. Although the LCDs would continue to allow steroid injections for Morton's neuroma, they would impose an unreasonable lifetime limit of two injections per side, sharply restricting a podiatric physician's ability to manage the condition effectively.

APMA's Research Committee worked closely with Carrier Advisory Committee (CAC) representatives on the APMA position. Three key recommendations are:

• Maintain coverage for steroid injections to treat Morton's neuroma because strong scientific and real-world evidence support their effectiveness.

• Remove the lifetime limit on Morton's neuroma steroid injections because no evidence justifies such a restriction.

• Add the tibial nerve at the tarsal tunnel as a covered indication because peer-reviewed research supports its safety and clinical benefit.

These recommendations are the foundation of APMA's advocacy as APMA engages with MACs, CAC representatives, and coalition partners to ensure Medicare coverage decisions reflect sound clinical evidence and protect patient access to proven, non-opioid pain management options.

Meeting dates vary by MAC jurisdiction between October 22 and October 30. Formal comments are due on November 8. APMA will provide updates as they become available.

Contact the APMA Advocacy Department with any questions or feedback.