CurrentCignaPolicy 0579

Mm_0579_Coveragepositioncriteria_Anesthesia_Services_Selected_Nerve_Blocks

Defines medical necessity criteria and coding for cervical plexus block as regional anesthesia for procedures involving the neck, shoulder, and/or clavicle region for Cigna-administered health benefit plans. Also summarizes background, evidence, and limited recommendations about other indications and anticoagulation considerations.

Policy Summary

PayerCigna

PolicyMm_0579_Coveragepositioncriteria_Anesthesia_Services_Selected_Nerve_Blocks

Policy CodePolicy 0579

Change TypeNew policy; annual review

Effective DateMay 15, 2026

Next Review DateMay 15, 2027

Key ActionReimbursement is provided only if the service is submitted with covered diagnosis/procedure codes and meets the policy criteria; claims without covered codes will be denied.

SourceLink

POLICY UPDATE CHANGES

New medical coverage policy created on 9/15/2025.

Annual Review noted 'No clinical policy statement changes.' on 5/15/2026.

8Listed Covered Indications

1Primary Unlisted Procedure Code

0Numeric Thresholds

Coverage Summary

This policy (Policy Number 0579) considers Cervical Plexus Block (CPB) covered with criteria for Cigna‑administered health benefit plans. Effective date: 05/15/2026; Last review: 05/15/2026; Next review: 05/15/2027. The policy defines medical necessity criteria for CPB for procedures involving the neck, shoulder, and/or clavicle and lists 8 covered indications. Coding guidance notes an applicable primary reporting code of 64999 (Unlisted procedure, nervous system) when criteria are met.