CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Neural therapy (therapeutic local anesthetic injections) — Coverage Criteria

This policy governs coverage for neural therapy (injections of local anesthetic into scars, trigger points, acupuncture points, peripheral nerves, autonomic ganglia, epidural space, and other tissues) for Blue Cross Blue Shield - Rhode Island members.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyNeural therapy (therapeutic local anesthetic injections) — Coverage Criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionVerify member benefits and eligibility; refer to the Benefit Booklet/Subscriber Agreement for coverage determinations.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

not medically necessarycoverage stance

not requiredprior authorization

unlisted CPTcoding

insufficientevidence

Coverage Criteria

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Not medically necessary: Neural therapy (injection of local anesthetics into scars, trigger points, acupuncture points, peripheral nerves, autonomic ganglia, epidural space, and other tissues) is considered not medically necessary for all indications due to insufficient evidence to determine effects on health outcomes.

Supported by statements that available studies are small, methodologically limited, and the evidence is insufficient to determine effects on health outcomes.

The available clinical evidence for neural therapy is limited and methodologically weak. Studies are small, and reported outcomes (symptoms, function, quality of life, medication use, and treatment-related morbidity) are insufficient to support a conclusion that neural therapy improves health outcomes. Because the evidence is inadequate to demonstrate clinically meaningful benefit, neural therapy is considered not medically necessary.

Provider Actions & Billing

Note

Prior Authorization

Not applicable (no prior authorization required).

Note

Benefit Verification Recommended

Benefits may vary by contract; refer to the member's Benefit Booklet/Subscriber Agreement for coverage details.

Denial Risk

Not Medically Necessary

Not medically necessary — denial risk. Neural therapy is considered not medically necessary for all indications; claims may be denied/not covered.

Background

Neural therapy involves injection of a local anesthetic (for example, procaine or lidocaine) into various tissues, including scars, trigger points, acupuncture points, tendon and ligament insertions, peripheral nerves, autonomic ganglia, and the epidural space. It is proposed for chronic pain and a range of other chronic conditions, but available studies are limited and do not provide sufficient evidence of effectiveness.

Definitions

Neural therapy — key definition entry(s).

TermNeural therapy

DefinitionInjection of a local anesthetic (such as procaine or lidocaine) into tissues (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 indications.

Alternate nameNeural acupuncture when injections are given into traditional acupuncture points.

Proposed mechanismsTheories include reestablishing nerve resting potential, treating 'interference fields', fascial continuity, ground (matrix) system, and lymphatic flow disruptions.

Distinction from nerve blocksDistinct from peripherally injected anesthetic agents used for nerve blocks or local anesthesia; injection sites may be located far from the source of symptoms.

Imaging Requirements

Billing Rule

Coding and imaging: use unlisted CPT code(s)

There are no specific HCPCS or CPT codes for neural therapy when local anesthetics are injected in this fashion; report the procedure using an unlisted CPT code.

No procedure-specific imaging or coding requirements are specified in the policy.