Headaches: Invasive Procedures (CPB 0707, reviewed 2026-07-23)

Immediately: Billing team must update Aetna authorization protocols and billing system rules to reflect this policy. (1) Flag all claims for occipital nerve blocks (CPT codes not specified in policy but procedures listed) as medically necessary when diagnosis is occipital nerve neuralgia or migraine—these require NO prior denial unless clinical criteria are unmet. (2) Configure system to DENY or REQUIRE PRIOR AUTHORIZATION for the following procedures when billed for cervicogenic headache, cluster headache, migraine prophylaxis, or unspecified chronic headache: ganglionectomy, sphenopalatine ganglion blocks (any method), C2 ganglion nerve blocks, cryo-denervation, radiofrequency ablation/denervation, occipital nerve decompression/micro-decompression, occipital nerve stimulation (ONSTIM, PRISM devices), dorsal column stimulation, electrical stimulation, auriculotemporal nerve blocks, cervical rhizotomy, trigeminal nerve procedures, and bariatric surgery. (3) Educate providers and front desk staff that these procedures are classified as experimental/investigational and will be routinely denied unless they can meet medical necessity thresholds defined in cross-referenced policies (CPB 0113, 0194, 0735). (4) Update encounter forms and EMR templates to require diagnosis codes and clinical justification for headache procedures. (5) Implement denial response templates citing CPB 0707 when rejecting non-covered procedures. Claims submitted without proper diagnosis documentation or for experimental procedures will be denied; failure to update system rules will result in improper approvals and subsequent recoupment.