Noridian peripheral nerve injection LCD L40265 and article A60300 take effect November 1; nerve blockade LCD L35456 and article A56034 retired October 31
Published November 8, 2026 · Coverage November 1–7, 2026, Pacific · Medium priority
The Medicare Coverage Database (MCD) lists Noridian Local Coverage Determination (LCD) L40265 (Peripheral Nerve Injections and Procedures for Chronic Pain) and billing article A60300 as effective November 1, 2026, and lists the Noridian Nerve Blockade for Treatment of Chronic Pain and Neuropathy LCD L35456 and article A56034 as retired October 31, 2026. Noridian's JE Part A and Part B update lists posted R1 notices for L40265 and A60300 on October 22, 2026, each stating an effective date of November 1, 2026. The LCD focuses on therapeutic injections or blocks and percutaneous denervation, usually radiofrequency ablation or cryotherapy, for the management of chronic pain, and does not address regional anesthesia, surgical pain, acute pain, and diagnostic injections unless specified; the billing article adds that the related LCD does not apply to botulinum toxins, blocks used to manage pain related to active malignancy refractory to medical management, spasticity treatment, joint impingement syndromes, or pain due to sympathetic neuropathies or neurotomies. Among its utilization parameters, the billing article states that no more than 2 radiofrequency sessions per knee for genicular nerve radiofrequency ablation, and a maximum of 4 occipital nerve blocks for occipital neuralgia, will be reimbursed per rolling 12 months.
Background
Medicare contractors are required to develop and disseminate LCDs, and a billing and coding article such as A60300 contains billing, coding or other guidelines that complement the LCD it supports. Noridian states that L40265 outlines limited coverage and was developed 'to update existing policy to evidence based and incorporate new procedures and literature.'
Who this affects
JE Part A and Part B providers that perform peripheral nerve injections and procedures for chronic pain, including hospital outpatient pain programs.
Why it matters
Inference: pain management and hospital outpatient billing should obtain and assess the new LCD and article, which the Medicare Coverage Database lists as effective 2026-11-01; claims edits, documentation templates and coding built on L35456/A56034 would need review.
Required actions
- Providers billing Noridian for these procedures: append the KX modifier to the line for initial diagnostic injections, and keep all documentation in the patient's medical record, available to the contractor upon request (billing article A60300).
Recommended action
- Obtain LCD L40265 and article A60300 and assess them against current billing and documentation for peripheral nerve injections; the Medicare Coverage Database lists both as effective 2026-11-01.
- Revenue Cycle and Compliance: compare L40265/A60300 coverage and coding with the retired L35456/A56034 and update edits and templates.
Scope and timing
- Authority status
- Effective
- Responsible owner
- Revenue Cycle
- Publication date
- Noridian notices 2026-10-22 (L40265 R1 and A60300 R1)
- Effective date
- 2026-11-01 (L40265; for A60300 this is the revision effective date, and its page shows an original effective date of 2026-10-25)
- Other dates
- MCD record last updated 2026-10-15 (L40265) and 2026-10-16 (A60300); L35456 and A56034 retirement date 2026-10-31
Not established
The LCD and article texts were read but were not compared with the retired L35456 and A56034; the coverage differences are not established. The MCD application programming interface (API) record names Noridian Part A and Part B without saying JE or JF; the Noridian JE update lists confirm JE for L40265/A60300 but say nothing about the retirement of L35456/A56034.
Sources
Complete edition and supplemental material
This article in the complete report →
Executive triage, source-coverage limitations, context and forward horizons remain in the complete report.
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