The policy lists specific CPT and HCPCS items as examples of codes not covered for the indications in this bulletin. Examples include codes for pulsed radiofrequency of the dorsal root ganglion, neurolytic epidural injections (e.g., 62281–62282), neurostimulator implantation (e.g., 63650, 63655), trigeminal nerve injections (e.g., 64400), intercostal nerve blocks (64420–64421), stellate ganglion injection (64510), and supplies/devices for electrical stimulation such as A4595 and E0720–E0731.

HCPCS/J-code listings also call out injectable agents and device-related items not covered for PHN indications, including examples such as J0585/J0587 (botulinum toxin), J2001 (IV lidocaine), and various methylprednisolone/dexamethasone HCPCS that are noted in the document as not covered in specified contexts.

Evidence summaries in the policy cite several specific treatments evaluated in the literature and conclude that many are unproven or have limited benefit. Noted examples include acupuncture, epidural methylprednisolone, epidural morphine sulfate, and iontophoresis of vincristine, while established first-line pharmacologic treatments such as tricyclic antidepressants, gabapentin, pregabalin, lidocaine patch, and opioids are described as effective. The topical capsaicin preparations (low-dose creams and the high-concentration 8% patch) are discussed as providing modest pain relief in some trials.

Randomized and systematic-review evidence for topical lidocaine is summarized as showing statistical pain relief versus placebo in pooled trials, supporting its role among topical options for PHN management.

The document segment focuses primarily on clinical evidence syntheses and study-level findings rather than issuing standalone coverage exclusion statements. Evidence summaries report which therapies lack sufficient randomized trial support or have equivocal results; explicit policy exclusion language is provided elsewhere in the CPB (coding/exclusion lists), but the background text itself emphasizes the evidence base rather than formal coverage determinations.

The UpToDate summaries cited in the policy note that interventions such as transcutaneous electrical nerve stimulation (TENS), transcranial magnetic stimulation (TMS), and acupuncture have not been proven effective for postherpetic neuralgia according to contemporary reviews, indicating limited endorsement of these modalities in that source.

An UpToDate review referenced by the policy does not list trigeminal (Gasserian) nerve block as a therapeutic option for PHN, and a separate UpToDate overview of chronic widespread pain does not mention the capsaicin 8% patch (Qutenza) in that context. These citations indicate that trigeminal nerve block and capsaicin patch have limited or absent endorsement in those UpToDate summaries.

Multiple interventions are identified in the policy as not of established benefit or unproven for PHN. Examples explicitly described in evidence summaries include epidural methylprednisolone, epidural morphine sulfate, iontophoresis of vincristine, sympathectomy, and several topical/alternative modalities (e.g., certain lasers, topical piroxicam). The policy distinguishes these approaches from therapies that have demonstrated benefit in randomized trials (e.g., gabapentin, pregabalin, tricyclic antidepressants, lidocaine patch).

Systematic reviews and randomized trials summarized in the policy provide moderate-quality evidence that corticosteroids given during the acute herpes zoster episode do not prevent post-herpetic neuralgia at 6 months. Five randomized, double‑blind, placebo‑controlled trials (total n=787) were assessed and meta-analyses reported no significant difference between corticosteroid and control groups for the primary prevention outcome.

The excerpt reporting corticosteroid trial results presents the evidence assessment and conclusions but does not itself use an explicit phrasing such as ‘not medically necessary’ within that background text. The policy’s coverage determinations and non-coverage lists appear elsewhere in the CPB, while this section focuses on the trial data and the reviewers’ judgment that corticosteroids are ineffective for PHN prevention.

The CPB enumerates a list of interventions and corresponding CPT/HCPCS examples that are designated as experimental or investigational for PHN indications. Representative items called out in the coding/exclusions sections include pulsed radiofrequency of the dorsal root ganglion, peripheral nerve stimulation, TENS devices and supplies (E0720–E0731, A4595), neurolytic epidural injections (62281–62282), neurostimulator implantation (63650, 63655), trigeminal nerve injection (64400), and various HCPCS drug codes associated with investigational agents.

The policy’s not-covered/code-exclusion listings repeat items that reflect the document’s assessment of insufficient evidence for PHN, such as pulsed radiofrequency, peripheral nerve stimulation, and TENS (device and supply codes). These examples are provided in the CPT/HCPCS lists of items not covered for the indications in the CPB.

Additional interventions named in the exclusions and code tables as experimental or unproven include extracorporeal shockwave therapy (0101T), certain ultrasound-guided transforaminal injection codes (0228T–0231T), and neurolytic procedures (62281–62282), all cited in the policy’s not-covered code sections.

The HCPCS/J-code section lists specific drug and device codes that the policy identifies as not covered for PHN indications in the examples provided. These include investigational injectables such as fulranumab and ganglioside GM1, the transdermal oxycodone patch (no specific CPT), and multiple injectable agents and supplies called out in the HCPCS list.

The exclusions table further references botulinum toxin codes (J0585, J0587) and IV medication administration codes such as J2001 (IV lidocaine) among the HCPCS items enumerated in the policy’s not-covered examples for PHN indications.

Device and implant procedure codes are included among the not-covered examples; these encompass peripheral neurostimulator/implantation codes (64555–64575, 63650–63655) and supplies for electrical stimulation (A4595), which the CPB lists as not covered for the indicated PHN uses.

Intravenous lidocaine is discussed in the evidence summaries as a therapy that may provide benefit for patients refractory to other treatments, but small controlled trials have not convincingly demonstrated superiority to placebo. The policy text notes this uncertainty in the literature but does not include an explicit statement in the excerpt declaring IV lidocaine as not covered.

The policy repeats various experimental or early‑phase interventions across its exclusion lists, including agents and modalities such as iontophoresis of vincristine, narrow-band UVB/laser therapies, and several topical agents; these are cited in the CPT/HCPCS and narrative background as unproven for PHN.

Herpes zoster results from reactivation of varicella‑zoster virus in dorsal root or cranial nerve ganglia and produces a unilateral dermatomal rash with associated acute neuropathic pain. When pain or dysesthesia persists for 3 months or more after the acute infection, the condition is defined as post‑herpetic neuralgia (PHN). Incidence increases with age and immunosuppression, and PHN pain presentations commonly include burning, lancinating pain and allodynia; both peripheral and central mechanisms contribute to the chronic neuropathic state.