G920 – Percutaneous cervical sympathetic nerve block or Stellate ganglion block

1. G920 and G234 are each limited to a maximum of one unilateral or one bilateral procedure per patient per day to a limit of 24 services for any combination of unilateral and bilateral procedures per patient per 12 month period. If, in the opinion of the treating physician, more frequent treatments are necessary, the physician may obtain written prior authorization from the MOH. Authorization will be dependent on the physician demonstrating that the increased frequency of the service is generally accepted as necessary for the patient under the circumstances.

2. G920, G234 and G236 are only eligible for payment same patient same day with other nerve block and/or injection services if rendered to diagnose or treat a separate condition.

3. G234 is not eligible for payment with G920 same patient same day.

4. The sympathetic block that may result from epidural, spinal, plexus and peripheral nerve blocks is not payable as G920, G234 or G236.