Medicare AdvantageBilling CodesMedium impact
MA08.026m, Treatments for Complex Regional Pain Syndrome (CRPS)
Independence Blue Cross·Pain Management, Anesthesiology, Neurology +1 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated Medicare Advantage policy MA08.026m for CRPS treatments effective 01/01/2026. HCPCS code C9812 (echogenic nerve block needles) was added as a covered medically necessary service, while J1572 (immune globulin injection) was initially deleted but restored on 01/08/2026 per CMS guidance. Billing teams must ensure both codes are active in systems and claims for nerve blocks include appropriate medical necessity documentation.
Action Required
By 01/15/2026: Billing team must verify that HCPCS code C9812 (echogenic nerve block needles) is enabled in the billing system as a covered medically necessary code for Medicare Advantage CRPS treatments, and that J1572 (immune globulin injection) remains active following the 01/08/2026 CMS correction. Update claim submission rules to automatically flag claims for C9812 to ensure they include documentation of: (1) failed first-line pain management for at least 2 weeks, (2) positive response to initial diagnostic stellate ganglion or lumbar sympathetic block, (3) sustained benefit demonstrated by decreased pain medication use, improved function, improved touch tolerance, 80% pain reduction, and 2°C temperature rise in ipsilateral limb, and (4) comprehensive pain management program enrollment. Providers must document all medical necessity criteria before submitting claims; claims lacking this documentation will be denied. Audit existing CRPS nerve block claims to identify any incorrectly denied C9812 claims for potential resubmission.