CommercialCoverageHigh impact
Nerve Blocks (CPB 0863, reviewed 2026-07-23)
Aetna·Anesthesiology, Orthopedics, Pain Management +11 more·Medical Policy
Effective date
Jul 23, 2026
We identified it
Aug 18, 2026
Summary
Aetna has updated its Nerve Blocks clinical policy (CPB 0863) effective 2026-07-23, establishing comprehensive medical necessity criteria for 40+ approved nerve block procedures and designating numerous others as experimental/investigational. Billing teams must immediately verify which nerve blocks are covered versus experimental to prevent claim denials. This policy applies to Aetna commercial plans and requires prior authorization verification for non-standard applications.
Action Required
IMMEDIATE ACTION REQUIRED: By 2026-07-23, billing team must: (1) Update billing system to flag nerve block procedures (CPT codes in the 64400-64999 range and related anesthesia codes) as requiring medical necessity review against Aetna's approved list; (2) Create internal reference guide listing approved nerve blocks (adductor canal, axillary approach brachial plexus, ESP block, femoral nerve, interscalene/suprascapular, IPACK, TAP block, etc.) versus experimental blocks (anterior scalene brachial plexus for chronic pain, auriculotemporal block, calcaneal nerve block, genicular nerve block, etc.); (3) Implement pre-billing verification: any nerve block NOT on the approved list requires documented medical justification and provider attestation before claim submission; (4) Update encounter templates and superbills to require providers to specify the surgical procedure and clinical indication (e.g., 'adductor canal block for total knee arthroplasty post-op pain'); (5) Train front desk and coding staff on new requirements; (6) Contact Aetna for prior authorization on experimental nerve blocks or off-label uses before service delivery. CONSEQUENCE: Claims for experimental or unapproved nerve blocks will be denied as not medically necessary. Claims lacking procedure-specific documentation will be subject to recoupment.