Medicare Peripheral Nerve Block Coverage Patient Toolkit
Medicare Peripheral Nerve Block Coverage Patient Toolkit
For Medicare Patients
Your care.
Your voice.
Concerned that Medicare may limit a peripheral nerve block your physician recommends? Tell Congress what access means to you.
Download the Sample Letter and Instructions to Contact Congress
Chronic pain can affect everyday activities and independence.
Your experience matters
Peripheral nerve blocks are injections near specific nerves. Depending on the patient and the purpose of treatment, a physician may use a nerve block to help identify the source of pain, guide another treatment, or try to relieve pain.
Medicare coverage policies for these procedures vary by location and by the policy that applies to a patient’s care. New policies from several Medicare contractors are scheduled to take effect on October 25, 2026. The policy for Noridian’s service areas is scheduled to take effect on November 1, 2026.
The policies include coverage for some procedures under defined conditions, while restricting or excluding others. A patient’s coverage depends on the applicable policy and individual circumstances. Ask your physician’s office which Medicare contractor and policy apply to your care.
Every patient’s experience with pain and treatment is different.
What you can ask Congress to do
Tell your representative and senators how coverage rules affect you. You may ask their offices to:
Ask for an explanation
Request that CMS and the Medicare contractors explain the clinical evidence and patient impact behind the coverage limits.
Review patient impact
Ask whether the policies account for patients’ medical circumstances, treatment history, pain relief, and functional improvement.
Clarify how policies can be reviewed
Seek clear information about how patients and clinicians can request reconsideration of a coverage policy.
Explain patient options
Ask what options are available when a physician recommends a procedure and Medicare does not cover it.
What to expect: Congressional offices can request information and raise concerns with federal agencies. Contacting Congress does not guarantee a change in coverage or resolve an individual claim.
Share your experience
You can write a personal message or adapt the sample below. Include details that feel comfortable to share, such as how pain affects your daily activities, what treatments you have tried, and how a coverage restriction could affect your care.
Find your officials
Use your ZIP code to find your U.S. representative and identify your two U.S. senators.
Tell your story
Share how pain affects your life and whether a recommended nerve block has helped or may be affected by coverage rules.
Send your message
Use your officials’ contact forms to send your message directly. You do not need to return it to your medical office.
Open a sample message to Congress
Subject: Please review Medicare coverage of peripheral nerve blocks
Dear Representative/Senator [Last Name],
My name is [Name], and I am a Medicare beneficiary and constituent in [City, State].
I live with [briefly describe your pain condition and how it affects your daily life]. My physician has recommended peripheral nerve block treatment to [describe the purpose, if known]. This care may help me [describe your experience or what you hope the treatment will help you do].
I am concerned that Medicare coverage policies for peripheral nerve procedures may limit access to care recommended by a patient’s physician. I ask you to contact CMS and the Medicare contractors responsible for these policies to learn what evidence supports the restrictions, how they may affect patients, and how the policies can be reviewed.
Please also ask what options are available to Medicare beneficiaries when a recommended procedure is not covered. I would appreciate a response about what your office learns and what steps may be available.
Thank you for considering my experience.
Sincerely,
[Name]
[City, State]
Frequently asked questions
What is a peripheral nerve block?
A peripheral nerve block is an injection near a nerve outside the brain and spinal cord. Physicians may use these procedures for diagnostic or therapeutic purposes. Whether Medicare covers a specific procedure depends on the applicable policy and the patient’s circumstances.
What is a Medicare Local Coverage Determination?
A Local Coverage Determination, or LCD, is a coverage policy issued by a Medicare Administrative Contractor (MAC). It applies within the contractor’s service area. There is not one single LCD that applies to every Original Medicare patient nationwide.
Will Medicare cover my recommended procedure?
This page cannot determine whether Medicare will cover an individual procedure. Coverage may depend on your location, the policy in effect, the procedure, the reason for treatment, and your medical documentation. Ask your physician’s office to review the applicable Medicare policy with you.
Does this apply to Medicare Advantage?
The new LCDs discussed here are local policies for Original Medicare. If you have a Medicare Advantage plan, ask your plan and physician’s office how your plan’s coverage rules apply to your care.
What if Medicare denies my claim?
Ask your physician’s office or Medicare plan for the reason for the denial and information about your appeal rights. Contacting Congress is separate from appealing a claim and does not replace the Medicare appeals process.
Let Congress Hear from Patients
Your personal experience can help elected officials understand how Medicare coverage decisions affect people living with chronic pain.
Your participation is voluntary and will not affect your medical care. Do not include your Medicare number, Social Security number, medical record number, or other sensitive personal information in a message to Congress.
This page is for general information and does not determine coverage for an individual procedure. Contacting Congress is separate from appealing a claim and does not replace the Medicare appeals process. Coverage policies can change; ask your physician’s office which policy applies to your care.