What Pain Management Practices Need to Know

In a May 28, 2026 update, Noridian Jurisdiction F Medicare Part B reinforced existing expectations regarding the use of anesthesia and sedation during interventional pain procedures.

The guidance applies to Medicare beneficiaries in:

• Alaska
• Arizona
• Idaho
• Montana
• North Dakota
• Oregon
• South Dakota
• Utah
• Washington
• Wyoming

While this is not a new Medicare policy, it serves as an important reminder that anesthesia billing remains an area of reimbursement scrutiny for pain management practices.

Practices that routinely bill moderate sedation, Monitored Anesthesia Care (MAC), or general anesthesia should review documentation and utilization patterns to help reduce denial and audit risk.

Which Procedures Are Affected?

According to Noridian, anesthesia services are generally not considered medically necessary for many common interventional pain procedures, including:

• Epidural Steroid Injections (ESIs)
• Facet Joint Injections
• Medial Branch Blocks
• Sacroiliac Joint Injections
• Trigger Point Injections
• Peripheral Nerve Blocks
• Shoulder, Hip, and Knee Joint Injections

The guidance references recommendations from leading pain management and anesthesia organizations, which generally support performing these procedures with local anesthetic alone or minimal sedation whenever appropriate.

When Is Anesthesia Considered Medically Necessary?

Noridian acknowledges that anesthesia or sedation may be appropriate in select circumstances, including:

• Significant medical comorbidities
• Severe anxiety that cannot be managed with oral medications
• Procedures requiring prolonged immobility
• Certain Radiofrequency Ablation (RFA) procedures
• Synovial cyst aspiration or rupture procedures

When anesthesia services are billed, documentation should clearly support the medical necessity for that specific patient and procedure.

What Are the Revenue Cycle Risks?

For pain management practices, the primary concern is reimbursement.

Claims that include moderate sedation, MAC, or general anesthesia may face:

• Increased scrutiny
• Additional documentation requests
• Claim denials
• Appeals and payment delays
• Potential audit exposure

Noridian also notes that frequent reporting of anesthesia services with pain management procedures may trigger focused medical review.

Action Steps for Pain Management Practices

Practice leaders should consider reviewing:

 Anesthesia utilization patterns

 Documentation supporting medical necessity

 Coding and billing workflows

 Denial and appeal trends

 Internal compliance monitoring processes

Proactive reviews can help reduce reimbursement risk and improve claim performance.

Why This Matters Beyond Noridian Jurisdiction F

This guidance applies directly to Medicare claims processed through Noridian Jurisdiction F. However, similar expectations regarding medical necessity and anesthesia billing exist across many Medicare Administrative Contractors and commercial payers.

Pain management practices nationwide should remain attentive to documentation requirements and evolving payer scrutiny.

How Peregrine Healthcare Helps Pain Management Practices

As reimbursement requirements continue to evolve, pain management practices face increasing pressure to maintain compliance while protecting revenue.

Peregrine Healthcare helps practices identify revenue cycle vulnerabilities, reduce denials, strengthen documentation workflows, and improve overall billing performance. Our team supports physicians and administrators with medical billing, denial management, credentialing, coding oversight, payer contracting, and revenue cycle consulting.

Request a Complimentary Revenue Cycle Assessment

Concerned about denial trends, documentation requirements, or reimbursement risk?

Peregrine Healthcare offers complimentary revenue cycle assessments designed to identify opportunities for improvement and uncover potential revenue leaks before they impact your bottom line.

  877-463-1110
peregrinehealthcare.com/contact-us

Based in Texas and Arizona. Trusted by Physicians Nationwide Since 2001.

Source: Noridian Medicare Part B, Jurisdiction F. Anesthesia/Sedation for Pain Management Procedures. Updated May 28, 2026.