Complex Regional Pain Syndrome (CRPS) / Reflex Sympathetic Dystro..

II. Aetna considers sympathetic blocks (e.g., stellate ganglion block [cervical sympathetic block] and lumbar sympathetic block) medically necessary for the treatment of CRPS when conservative treatments, including analgesia and physical therapy, have failed. Up to 3 sympathetic blocks are considered medically necessary to diagnose a member's pain and achieve a therapeutic effect; if the member experiences no pain relief after 3 injections, additional injections are not considered medically necessary. Repeat sympathetic blocks for CRPS beyond the first 3 injections are considered medically necessary when provided as part of a comprehensive pain management program, which includes physical therapy, patient education, psychosocial support, and oral medications, where appropriate. It is not considered medically necessary to repeat sympathetic blocks more frequently than once every 7 days.