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AetnaAll Plans · Coverage · Medical Policy · Neurology, Neurosurgery, Pain ManagementMedium impact

Trigeminal Neuralgia: Treatments (CPB 0374, reviewed 2026-06-29)

Effective date
Not stated in the notice
Identified
Aug 18, 2026

Summary

Aetna considers surgery for trigeminal neuralgia medically necessary when the condition has persisted for at least 6 months despite pharmacotherapy (carbamazepine, oxcarbazepine, lamotrigine, baclofen, gabapentin, pregabalin or phenytoin) or the member is unable to tolerate the side effects of those medications. The medically necessary procedures are balloon compression, CyberKnife, gamma knife, microvascular decompression, percutaneous glycerol rhizotomy (or injections), percutaneous radiofrequency rhizolysis or rhizotomy, and trigeminal nerve blocks for refractory cases, while surgery that does not meet these criteria is considered experimental, investigational, or unproven. Acupuncture, botulinum toxin, pulsed radiofrequency, spinal cord stimulation, deep brain stimulation, intravenous ketamine, intravenous lidocaine, erenumab and trigeminal tractotomy are considered experimental, investigational, or unproven because their effectiveness has not been established.

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What to do

Action · 6 steps
01Billing team: Before billing the surgical codes listed as covered, confirm the chart shows that trigeminal neuralgia has persisted for at least 6 months despite pharmacotherapy with carbamazepine, oxcarbazepine, lamotrigine, baclofen, gabapentin, pregabalin or phenytoin, or that the member is unable to tolerate the side effects of those medications.
02Bill the covered procedure codes, for example CPT 61790 and 64600, only for members who meet those criteria.
03Do not bill the experimental, investigational, or unproven treatments listed in the policy as covered services, including acupuncture, botulinum toxin, pulsed radiofrequency, spinal cord stimulation, deep brain stimulation and trigeminal tractotomy.
04Topical ambroxol, erenumab and intravenous ketamine are not covered for the indications listed in the policy.
05ICD-10 B02.22 (postherpetic trigeminal neuralgia) is listed as not covered for the indications in the policy.
06For ICD-10 G35.A through G35.D (multiple sclerosis), combined radiofrequency thermocoagulation and pulsed radiofrequency is not covered.

Codes mentioned

6145061458614606179061796617976179861799644006460064605646106461264716647326473495867G0173G0251G0339G0340G50.0B02.22

Original notice

Trigeminal Neuralgia: Treatments (CPB 0374, reviewed 2026-06-29)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesNeurologyNeurosurgeryPain ManagementCode 61450Code 61458Code 61460Code 61790Code 61796Code 61797Code 61798Code 61799Code 64400Code 64600Code 64605Code 64610Code 64612Code 64716Code 64732Code 64734Code 95867Code G0173Code G0251Code G0339Code G0340Code G50.0Code B02.22

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