ModifiedCignaPolicy 0579

Cervical Plexus Block

Defines medical necessity criteria for cervical plexus nerve block for procedures involving the neck, shoulder, and/or clavicle region, lists applicable CPT/unlisted procedure code, summarizes evidence and Medicare LCD/NCD pointers, and provides coding and revision details for Cigna plans.

Policy Summary

PayerCigna

PolicyCervical Plexus Block

Policy CodePolicy 0579

Change TypeNew policy

Effective DateSep 15, 2025

Next Review DateSep 15, 2026

Key ActionProviders should document that the cervical plexus block is for one of the listed medically necessary procedures and submit services with matching diagnosis/procedure codes to support medical necessity; claims without covered codes will be denied.

POLICY UPDATE CHANGES

New medical coverage policy created for Cervical Plexus Block.

9Covered Indications Listed

1Primary Listed Billing Code (unlisted)

0.9Confidence Score

Coverage Summary

Coverage stance: covered_with_criteria. Policy Number: 0579. This policy defines medical necessity criteria for Cervical Plexus Block for procedures involving the neck, shoulder, and/or clavicle. Effective Date: 2025-09-15; Last Review Date: 2025-09-15; Next Review Date: 2026-09-15.

Scope: This coverage policy addresses the use of cervical plexus nerve block to provide pre- and postoperative pain relief and regional anesthesia for surgical and nonsurgical procedures of the neck, shoulder, and clavicle, and lists the specific indications that meet medical necessity criteria.

Cervical Plexus Block — Key Policy Details

Policy Number0579

StatusMODIFIED

Effective Date2025-09-15

Last Review2025-09-15

Next Review2026-09-15

Scope SummaryDefines medical necessity criteria for cervical plexus nerve block for procedures involving the neck, shoulder, and/or clavicle region; lists applicable unlisted procedure code (64999), summarizes evidence and Medicare LCD/NCD pointers, and provides coding and revision details for Cigna plans.

Medical-Necessity Criteria

Medically Necessary

Cervical plexus block is considered medically necessary for procedures involving the neck, shoulder and/or clavicle region, including ANY of the following:

Medically Necessary indications

acromioclavicular dislocations
anterior cervical discectomy fusion
carotid endarterectomy
ear surgery
lymph node biopsy, dissection, located in the neck region
open reduction and internal fixation (ORIF) of the clavicle
shoulder surgery (e.g., rotator cuff repair, arthroplasty)
superficial neck surgery (e.g., thyroidectomy, parathyroidectomy)
treatment of clavicle fractures (e.g., open reduction and internal fixation (ORIF) of the clavicle)

Not Medically Necessary

Cervical plexus block is considered not medically necessary if the above criteria are not met.

Not Medically Necessary: Procedure/invocation does not involve the neck, shoulder, and/or clavicle region or is not one of the listed indications

Coding

Considered Medically Necessary when criteria metmixedCovered

64999

Unlisted procedure, nervous system

Note: 64999 is listed for reporting this service as an unlisted procedure, nervous system. When billing an unlisted code, providers must submit operative and diagnosis details that demonstrate the service meets the policy's covered indications and use the most appropriate codes effective on the date of service.

Providers should document the indication and relation to a covered procedure (for example, carotid endarterectomy, thyroidectomy, shoulder surgery, ORIF of the clavicle) and follow the billing rule that deleted or inactive codes at the time of service may not be eligible for reimbursement.

Provider Actions

Prior Authorization

Coverage requires meeting listed indications

Providers must submit services with diagnosis/procedure codes that match the coverage policy; claims for services not accompanied by covered codes under this policy will be denied as not covered.

Affected codes: 64999
Note: Claims lacking matching covered codes under this policy will be denied as not covered.

Documentation Required

Document indication and relation to covered procedures

Providers should document that the cervical plexus block is for one of the listed medically necessary procedures and include operative/diagnosis details to support medical necessity.

Carotid endarterectomy
Thyroidectomy (superficial neck surgery)
Shoulder surgery (e.g., rotator cuff repair, arthroplasty)
Clavicle open reduction and internal fixation (ORIF)

Billing Rule

Use most appropriate codes as of service date

When billing, providers must use the most appropriate codes effective on the date of service; deleted or inactive codes at time of service may not be eligible for reimbursement.

Verify that the code is active and effective on the date of service.
When reporting an unlisted procedure code, include operative detail to support the service billed.

Background & Evidence

Regional anesthesia via cervical plexus block provides anesthesia and postoperative analgesia for the neck, shoulder, and clavicle. Ultrasound guidance and nerve stimulator techniques are commonly used to locate anatomic structures. Blocks may be administered as a single injection or continuously via catheter and are performed by anesthesiologists, surgeons, or emergency physicians for both surgical and certain emergency procedures.

The superficial, intermediate, and deep approaches target the cervical plexus (C2–C4); superficial CPB is valued for ease of administration and anesthetizes cutaneous areas including the posterior earlobe, parts of the mandible, and the clavicle region. Literature supports clinical usefulness for selected conditions.

Evidence	Findings
Systematic review: Wilson et al., 2023
BSCPB prolonged duration of analgesia and reduced post-thyroidectomy opioid consumption (p<0.001); lower 24‑hour VAS, reduced intraoperative morphine and rescue analgesia, and reduced PONV (p=0.02)
Randomized trials: Kamel 2024; Kruc 2024; Kilbasanli 2023; Abdelghany 2021
Multiple RCTs demonstrate efficacy for various procedures: differences in onset, duration, time to first analgesia, reduced opioid/rescue analgesic use, and some advantages in performance time or reduced complications (e.g., shorter performance time and faster onset in IC vs ES; extended analgesia when SCB combined with CSB; improved VAS and lower opioid use vs GA; SCP acceptable for ORIF with less diaphragmatic hemiparesis)

Cervical Plexus Block (CPB): A regional anesthetic technique targeting the cervical plexus (C2–C4) to provide anesthesia and analgesia to the neck, shoulder, and clavicle regions; may be performed as superficial, intermediate, or deep approaches and delivered as single injection or continuous catheter infusion.

Determination	Details
No Determination found
Type: NCD; Number: (none listed)
Peripheral Nerve Blocks
Type: LCD; Number: (multiple/local varies); Effective: varies