Headaches: Invasive Procedures (CPB 0707, reviewed 2026-10-15)

Billing team must immediately review this policy's coverage determinations for invasive headache procedures submitted to Aetna. Verify that submitted procedures align with the specific headache diagnosis classifications: (1) Occipital nerve blocks are medically necessary only for occipital nerve neuralgia and other headaches including migraines—ensure diagnosis codes support this; (2) For cervicogenic headaches, botulinum toxin is experimental/investigational except when criteria in CPB 0113 are met; (3) For occipital neuralgia and other headache types, procedures listed as experimental/investigational (including electrical stimulation, radiofrequency ablation, nerve decompression, neurectomy, ganglionectomy, and thermal neurolysis) should not be billed unless prior authorization explicitly approves them; (4) For cluster headaches and chronic migraines, surgical interventions and nerve blocks listed as not covered should be denied or subject to prior authorization review. Update billing software and prior authorization workflows to require diagnosis-specific medical necessity verification before processing claims for affected CPT codes (14040-14061, 15824-15826, 20550-20551, 30130-30140, 30520, 31240, 37600-37609, 43631-43888, 61796-61885). Failure to align submissions with this policy's coverage classifications will result in claim denials for non-covered procedures.