Physician Action Alert: Protect Access to RFA Procedures & Peripheral Nerve Blocks

Several Medicare Administrative Contractors (MACs) have released proposed Local Coverage Determinations (LCDs) that would classify peripheral nerve blocks and radiofrequency ablation (RFA) procedures—including genicular, shoulder, and hip—as “not reasonable and necessary."

If finalized, these LCDs could significantly restrict patient access to established chronic pain treatments that are widely recognized as safe and effective.

Before these policies are finalized, MACs must hold an open public comment period—and your feedback truly makes a difference.

NANS is submitting a unified response with other specialty societies, but MACs give the greatest weight to comments from practicing clinicians. Add your voice to help protect patient access to medically necessary, evidence-based pain therapies. 

How To Participate
Each MAC has a comment window and open meeting for stakeholders to share feedback. To make your voice heard:

1. Identify your MAC and jurisdiction on the map below.
2. Review the proposed LCD for “Peripheral Nerve Blocks and Procedures for Chronic Pain.”
3. Register for your MAC’s open meeting (optional).
4. Submit written comments before the stated deadline.

NOTES:
-States without their MAC listed do not have a proposed LCD.
-Virginia has a Part B county exception (Arlington, Fairfax, City of Alexandria). Please confirm details on your MAC page.
-American Samoa, Guam, and Northern Mariana Islands fall under Noridian (Jurisdiction E).

Click on your MAC for more details on how to make your voice heard:

Noridian ›

View Proposed LCD

Open Meeting (JE Part B) Thursday, Oct. 30, 2–4 PM CT — REGISTER NOW

Comment Deadline: 11/8/2025

Where to Submit Comments:

Contractor Medical Director (s) Noridian Healthcare Solutions, LLC Attention: Draft LCD Comments 4510 13th Ave. S, STE1 Fargo, ND 58103-6646 Send Letter to: [email protected]

NGS ›

View Proposed LCD

Open Meeting: Thursday, Oct. 30, 11 AM–1 PM CT — REGISTER NOW

Comment Deadline: 11/8/2025

Where to Submit Comments:

National Government Services Medical Policy Unit P.O. Box 7108 Indianapolis, IN 46207-7108 Send Letter to: [email protected]

CGS ›

View Proposed LCD

Open Meeting: Tuesday, Oct. 28, 3–4:30 PM CT — REGISTER NOW

Comment Deadline: 11/8/2025

Where to Submit Comments:

Meredith Loveless, MD Attn: Medical Review 26 Century Blvd., Ste ST610 Nashville, TN 37214-3685 Send Letter to: [email protected]

Palmetto ›

View Proposed LCD

Open Meeting (JM & JJ): Monday, Oct. 27 -

REGISTER NOW

Comment Deadline: 11/8/2025

Where to Submit Comments:

Part A Policy PO Box 100238 (JM) or PO Box 100305 (JJ) AG-275 Columbia, SC 29202 Send Letter to: [email protected]

WPS ›

View Proposed LCD

Open Meeting: Wednesday, Oct. 22 — REGISTER NOW

Comment Deadline: 11/22/2025

Where to Submit Comments:

Claudia Campos MD, FACP 1717 W. Broadway Madison, WI 53701-1787 Send Letter to: [email protected]

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Suggested Talking Points:

• Length of time in practice, experience performing peripheral nerve blocks and RFA
• Your patient demographic (e.g., % Medicare patients)
• Patient selection criteria – how you identify patients for peripheral nerve blocks and RFA
  • Typical treatment algorithm for chronic pain patients and where nerve blocks and RFA fit within the algorithm
• Outcomes achieved in your practice compared to published data
• Include any publications that you are an author of

• Consequences if nerve blocks and ablations were no longer available. What will patients have as options (e.g., increased surgical interventions, opioid use, delayed care)
• The policy is counter to Medicare’s effort to combat opioid epidemic.

More than a dozen leading pain societies, including NANS, submitted joint letters to the MACs urging them to rescind or postpone the proposed LCDs and to instead adopt evidence-based policies grounded in the most current research and key clinical considerations.

Read Letter