Transversus abdominis plane (TAP) block for abdominal surgery.Stellate ganglion block for diagnosis and treatment of sympathetically-mediated pain, and diagnosis and treatment of complex regional pain syndrome (CRPS) of the hand and arm if it is used as part of a rehabilitation program and the member has failed standard pharmacotherapies (e.g., non-steroidal anti-inflammatory drug, topical lidocaine cream).
Splanchnic nerve block for the treatment of cancer/malignancy pain. Saphenous nerve block for post-operative pain management. Rectus sheath block for post-operative pain control after cholecystectomy. Radial nerve block for post-operative pain control after carpometacarpal joint arthroplasty and De Quervain’s tendon release. Quadratus lumborum nerve block for post-operative pain control after abdominal surgeries. Pre-operative adductor canal block for post-operative pain management after anterior cruciate ligament reconstruction. Posterior tibial nerve block for post-operative pain control after Achilles tendon repair. Popliteal block for hallux valgus correction surgery, and open reduction internal fixation of ankle fracture. Peripheral nerve blocks for the treatment of chronic pain post-herniorrhaphy to avoid more aggressive treatments (e.g., surgery), and post-operative pain control after arthroscopic debridement of the ankle. for chronic pain only as part of an active component of a comprehensive pain management program. 
Peripheral nerve blocks (continuous or single-injection) for the treatment of. Pectoral plane nerve blocks for post-operative pain control after breast cancer surgery/mastectomy. 
Lumbar plexus block for post-operative pain control after THA. Lateral femoral cutaneous nerve block for meralgia paresthetica (lateral femoral cutaneous nerve entrapment) when conservative management (e.g., non-opioid analgesics or anticonvulsants such as carbamazepine, gabapentin or phenytoin) has failed and pain control after total hip arthroplasty (THA). IPACK (infiltration between popliteal artery and capsule of the knee) block for pain control following ankle arthroplasty, anterior cruciate ligament repair, knee arthroscopy, medial meniscectomy, or total knee arthroplasty. Interscalene/suprascapular nerve block for pain control in shoulder surgeries (arthroscopic or open). Intercostobrachial nerve block for management of tourniquet pain during surgery. Intercostal nerve blocks for acute intercostal pain, and for chronic intercostal neuritis as part of a comprehensive pain management program. Infraclavicular nerve block in upper extremity surgery. Inferior alveolar nerve block for refractory facial/jaw pain if member has failed conventional pain medications (e.g., NSAIDs including Toradol). Femoral-sciatic nerve block for lower limb surgeries. Femoral nerve blocks for acute post-operative pain after knee replacement surgery. Fascia iliaca block for acute hip fracture, and post-operative pain control following hip (including arthroscopic hip surgery) and knee surgeries. Cervical plexus block (superficial and deep) for post-operative analgesia after anterior cervical discectomy fusion, and for neck surgery (e.g., thyroid surgery) and regional anesthesia for carotid endarterectomy. 
Celiac nerve block for the treatment of cancer/malignancy pain.Number: 0863 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background ReferencesĪetna considers the following nerve blocks medically necessary:
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