CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Neural therapy

Defines coverage stance for neural therapy (injection of local anesthetic into scars, trigger points, acupuncture points, peripheral nerves, autonomic ganglia, epidural space, and other tissues) for commercial and Medicare Advantage products; notes benefits may vary by contract and refers to benefit booklet for member-specific coverage.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyNeural therapy

Policy CodePolicy N/A

Change TypeProvider Update (no material changes)

Effective Date

Next Review Date

Key ActionRefer to the applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for member-specific coverage determinations.

SourceLink

POLICY UPDATE CHANGES

No material clinical/coverage changes

Not coveredCoverage stance

Unlisted CPTProcedure coding

2017-2021Publication history

Coverage Summary & Determination

Neural therapy involves injection of a local anesthetic (e.g., procaine or lidocaine) into tissues such as scars, trigger points, acupuncture points, tendon and ligament insertions, peripheral nerves, autonomic ganglia, the epidural space, and other tissues to treat chronic pain and other proposed conditions. The policy's overall stance is that neural therapy is not covered / considered not medically necessary for all indications because the evidence is insufficient to determine effects on health outcomes.

Policy Statement / Coverage Determination

Neural therapy is covered only when criteria are met; policy states not covered due to insufficient evidence:

Neural therapy is not covered as the evidence is insufficient to determine the effects of the technology on health outcomes.
For Commercial Products: Neural therapy is considered not medically necessary for all indications as the evidence is insufficient to determine the effects of the technology on health outcomes.

Medical Necessity Details

Additional Criteria / Notes

The policy classifies neural therapy as not medically necessary due to insufficient evidence; no additional structured initial/continuation criteria are provided.

Initial/Continuation Criteria: Neural therapy is considered not medically necessary for all indications as the evidence is insufficient to determine the effects of the technology on health outcomes.

Few randomized trials and case series with methodologic limitations preclude conclusions on efficacy.

Procedure Coding Guidance

Procedure coding guidanceCPT

unlisted CPT

There are no procedure codes; an unlisted CPT code would be used to report neural therapy procedures.

There is no specific CPT procedure code for neural therapy; when performing neural therapy clinicians should report the service using an unlisted CPT code per the coding guidance and applicable payer billing rules. Benefits and billing may vary by contract, so providers must also refer to the member's Benefit Booklet or Evidence of Coverage for member-specific coverage determinations.

What Providers Need to Know

Denial Risk

Services may be denied as not medically necessary

Neural therapy services are considered not medically necessary and are therefore subject to denial; providers should not charge members unless prior informed consent and agreement to pay privately is obtained per member contract rules.

Do not charge members for services determined to be not medically necessary unless the member has been informed and has agreed in advance to pay privately.

Documentation Required

Refer to Benefit Booklet for member-specific coverage

Benefits may vary between groups/contracts. Providers must refer to the applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for member-specific coverage determinations.

Billing Rule

Report using unlisted CPT when applicable

If performing neural therapy, use an unlisted CPT code to report the procedure as there is no specific procedure code.

unlisted CPT

Background & Evidence Summary

Neural therapy is a technique in which a local anesthetic (commonly procaine or lidocaine) is injected into a variety of sites — including scars, trigger points, acupuncture points, tendon and ligament insertions, peripheral nerves, autonomic ganglia, and the epidural space — with the goal of relieving chronic pain. When the anesthetic is injected into traditional acupuncture points, the procedure may be termed neural acupuncture.

It has been proposed for chronic pain and a wide range of other conditions (for example, allergies, infertility, tinnitus, depression, chronic bowel problems, headaches, arthritis, asthma, and others). The evidence for these indications comprises small randomized trials and case series with methodological limitations; there are few English-language reports and the available studies are insufficient to establish efficacy.

Evidence Summary

Unsupported block type: paragraph

Definitions

Unsupported block type: definition