CurrentBlue Cross Blue Shield - MassachusettsPolicy 914

Neural Therapy (injectable local anesthetic for chronic pain)

This policy governs coverage of neural therapy (injection of local anesthetic into scars, trigger points, autonomic ganglia, acupuncture points, etc.) for commercial and Medicare members of Blue Cross Blue Shield of Massachusetts; it states the service is investigational and not covered for outpatient settings.

Policy Summary

PayerBlue Cross Blue Shield - Massachusetts

PolicyNeural Therapy (injectable local anesthetic for chronic pain)

Policy CodePolicy 914

Change TypeNo material change

Effective Date

Next Review Date

Key ActionPrecertification/preauthorization is required when neural therapy is performed inpatient.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Investigationalcoverage stance for neural therapy

Not coveredoutpatient coverage

Preauth requiredinpatient authorization

Policy #914document identifier

Annualreview frequency

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Coverage Criteria

Not covered / Investigational

Coverage stance

Policy statement: Neural therapy is considered INVESTIGATIONAL for all indications.

Applies to all member products listed; see outpatient non-coverage specifics.

Outpatient Not Covered

Outpatient service coverage

Outpatient non-coverage: Commercial Managed Care (HMO and POS), Commercial PPO and Indemnity, Medicare HMO Blue SM, and Medicare PPO Blue SM: outpatient neural therapy is not a covered service.

Lists multiple product lines with identical outpatient non-coverage.

Neural therapy is investigational and not a covered outpatient service for all product lines listed. Specifically, for Commercial Managed Care (HMO and POS), Commercial PPO and Indemnity, Medicare HMO Blue SM, and Medicare PPO Blue SM, outpatient neural therapy is not a covered service. The policy also states broadly that neural therapy is considered INVESTIGATIONAL for all indications.

The evidence summary in this policy supports an investigational stance: neural therapy is described as investigational for all indications and diagnoses. The policy explicitly notes investigational status across diagnoses (ICD codes), indicating that current evidence is insufficient to establish improvement in net health outcome for the range of proposed indications.

Coding

CPT CodesCPT

No codes listed

ICD Diagnosis CodesICD-10Not Covered

No codes listed

Provider Actions & Billing

Prior Authorization

Inpatient prior authorization required

For services described in this policy, precertification/preauthorization is required when the procedure is performed inpatient. Obtain authorization prior to admission to avoid claim denials or delays.

Applies to all products when performed inpatient

Note

Provider action

See Authorization Information for applicable commercial and Medicare prior authorization requirements.

Documentation Required

Coding and documentation note

Background

Neural therapy refers to injections of local anesthetic (for example, procaine or lidocaine) into specific anatomic sites such as scars, trigger points, acupuncture points, peripheral nerves, autonomic ganglia, the epidural space, tendon and ligament insertions, and similar tissues. It is proposed to treat chronic pain and other conditions by correcting so-called interference fields or abnormal bioelectrical states, but the policy concludes the approach is investigational overall.

Definitions

Neural therapy — definition and intended mechanism

DefinitionInjection of a local anesthetic (eg, procaine or lidocaine) into specific sites — scars, trigger points, acupuncture points, tendon and ligament insertions, peripheral nerves, autonomic ganglia, the epidural space, and other tissues.

Intended mechanismProposed to re-establish normal resting potential of nerves and restore 'energy' flow by correcting so-called 'interference fields' or abnormal electrochemical states.

Primary purposePromoted mainly to relieve chronic pain; also proposed for a variety of other chronic conditions (eg, allergies, headaches, tinnitus, infertility, multiple sclerosis, chronic bowel problems).

Alternate nameWhen local anesthetic is injected into traditional acupuncture points, the procedure may be called 'neural acupuncture'.

Injection sites (examples)Scars; trigger points; acupuncture points; tendon and ligament insertions; peripheral nerves; autonomic ganglia; epidural space; other tissues.

Conservative Treatment Requirements

Imaging Requirements

Note

Imaging not required for neural therapy

No imaging studies are required by this policy to perform neural therapy.

Not Covered

Consistent with the policy conclusions, neural therapy is investigational and not covered when billed as an outpatient procedure across the commercial and Medicare product lines listed. Because the policy designates neural therapy as investigational for all diagnoses, outpatient claims for these procedures are subject to denial for lack of coverage.