Pain Treatment Access Cut: ASA Fights LCD (2025)

If you manage chronic pain through specialized procedures, your insurance coverage just got complicated. A Medicare Administrative Contractor (MAC) issued a Local Coverage Determination (LCD) that threatens access to certain pain management treatments—and the American Society of Anesthesiologists (ASA) is fighting back.

The stakes? Thousands of chronic pain patients could lose coverage for procedures their doctors prescribe. ASA argues the LCD lacks evidence-based justification and could force patients toward less effective alternatives or expensive out-of-pocket payments.

Here’s what’s happening, who’s affected, and what you can do.

What’s a Local Coverage Determination (And Why Should You Care)?

Most insurance rules get set nationally. LCDs work differently.

Medicare Administrative Contractors—private companies that process Medicare claims in specific regions—issue LCDs to determine which treatments and procedures get covered in their areas. Unlike national coverage decisions that apply everywhere, LCDs create regional variations in what Medicare pays for.

Think of it this way: The same pain management procedure might get covered in Texas but denied in Florida, depending on which MAC issued the LCD.

For patients, this creates a frustrating reality: Your ZIP code determines your treatment options.

• Regional authority. MACs operate in specific geographic zones, making coverage decisions for Medicare beneficiaries in those areas only.
• Evidence standards vary between contractors, leading to inconsistent coverage across state lines.
• LCDs can restrict coverage even when national Medicare policy doesn’t specifically prohibit a treatment.
• Doctors face claim denials for procedures they consider medically necessary, forcing difficult conversations with patients about alternatives or costs.

This particular LCD targets pain management procedures, but ASA hasn’t disclosed which specific treatments are affected or which MAC issued the determination. That lack of transparency compounds patient anxiety.

ASA’s Core Argument: “Not Evidence-Based”

The American Society of Anesthesiologists represents over 56,000 physician anesthesiologists nationwide. When they call an LCD “not evidence-based,” they’re questioning whether the MAC used rigorous clinical data to justify coverage restrictions.

Here’s their concern: If the LCD doesn’t reflect current medical consensus, it forces doctors to choose between providing optimal care and securing insurance payment.

Medical societies like ASA typically challenge LCDs when they believe:

Red Flag	Why It Matters
Outdated research	LCD cites studies from 10+ years ago, ignoring recent clinical advances
Selective evidence	MAC cherry-picks data supporting restriction while ignoring contradictory findings
No specialist input	MAC didn’t consult pain management experts before drafting LCD
Cost-driven logic	Decision prioritizes budget over patient outcomes

ASA mobilized its members immediately after the LCD publication, urging them to submit comments during the public feedback period. That rapid response signals the organization views this as a significant threat to patient care, not a minor administrative adjustment.

Who Gets Hit by This Coverage Change?

Without specific details on the procedures or MAC region involved, estimating affected patient numbers proves difficult. But chronic pain affects roughly 50 million U.S. adults, according to the CDC.

If this LCD covers even a narrow subset of pain management techniques, the impact could reach tens of thousands of Medicare beneficiaries.

Likely affected patient groups:

• Medicare beneficiaries over 65 using interventional pain procedures for arthritis, neuropathy, or post-surgical pain.
• Disabled Medicare recipients under 65 who qualify through Social Security Disability Insurance (SSDI)—many rely on pain management to maintain function.
• Veterans with Medicare coverage (not VA benefits) who need civilian pain specialists.
• Chronic condition patients with cancer, degenerative disc disease, or complex regional pain syndrome requiring specialized interventions.

The human cost? Patients losing LCD coverage face three bad options:

1. Pay full price out-of-pocket for the procedure (often $2,000-$15,000 depending on complexity)
2. Switch to less effective treatments covered by the LCD
3. Go without pain management, reducing quality of life and potentially increasing disability

Pain management physicians also take a hit. Denied claims cut revenue, forcing practices to reduce services or stop accepting Medicare patients altogether—shrinking access further.

Can You Fight an LCD Denial?

Yes, but the process favors persistence.

If your doctor prescribes a treatment restricted by an LCD, you have appeal rights through Medicare’s five-level system. However, success requires documentation proving “medical necessity” despite the LCD’s coverage criteria.

Your action plan if affected:

• Get detailed documentation from your physician explaining why the restricted procedure is necessary for your specific condition and why alternatives won’t work.
• File a redetermination (Level 1 appeal) within 120 days of the claim denial—include all medical records supporting your case.
• Contact ASA’s advocacy team through their advocacy page to report how the LCD affects your care. Patient stories strengthen their negotiating position with CMS.
• Check if your state medical society or patient advocacy groups are coordinating opposition to the LCD. Collective action works better than individual appeals.

ASA is also urging stakeholders to submit public comments on the LCD. While the article doesn’t specify a deadline, LCD comment periods typically run 30-45 days after publication. Check the MAC’s website or CMS Medicare Coverage Database for details.

How Medical Societies Challenge LCDs (And Win)

ASA’s fight follows a proven playbook specialty societies use to reverse problematic LCDs.

The strategy centers on demonstrating that the LCD contradicts accepted medical evidence. Here’s how it works:

1. Submit formal comments during the public feedback period, citing peer-reviewed studies supporting the restricted treatments.
2. Mobilize physician members to provide real-world case examples showing patient harm from coverage restrictions.
3. Request a meeting with MAC medical directors to present clinical evidence directly.
4. If the MAC doesn’t budge, escalate to the Centers for Medicare & Medicaid Services (CMS) to challenge the LCD as inconsistent with national policy.
5. In extreme cases, pursue litigation arguing the LCD violates Medicare statute or regulations.

Success rate varies. Some LCDs get revised after public comment. Others require years of advocacy and multiple escalation attempts. The outcome depends on the strength of clinical evidence and the MAC’s willingness to reconsider.

Recent wins give advocates hope. In 2023, anesthesiologists successfully challenged an LCD restricting spinal cord stimulation coverage, getting the MAC to expand criteria after presenting data on long-term patient outcomes.

The Bigger Picture: Why This Keeps Happening

LCD controversies aren’t new. They reflect a fundamental tension in healthcare: Cost containment vs. access to care.

MACs face pressure to control Medicare spending. When new procedures emerge or utilization increases, contractors sometimes tighten coverage criteria to manage costs. The problem? Those decisions don’t always align with clinical best practices.

Pain management gets targeted frequently because:

• Costs can escalate quickly with repeated procedures or advanced techniques like neuromodulation.
• Evidence quality varies—some interventions have robust research support, others rely on smaller studies or clinical experience.
• Utilization grew rapidly over the past decade as opioid prescribing declined and patients sought alternatives.
• MACs struggle to differentiate appropriate use from overutilization without specialist input.

The system creates perverse incentives. Instead of covering effective pain management that reduces long-term disability, LCDs sometimes push patients toward cheaper but less effective options. That saves money short-term but may increase costs later through disability payments, emergency care, or mental health treatment for depression related to uncontrolled pain.

What Happens Next?

ASA’s advocacy will likely follow the staged approach outlined above. Expect:

• Heavy physician engagement during the comment period, with anesthesiologists submitting clinical case data and research citations.
• Media outreach highlighting patient stories about lost access to effective pain treatments.
• Potential coalition building with other medical societies (pain management specialists, neurologists, physiatrists) and patient advocacy groups.
• If the MAC doesn’t revise the LCD after public comment, escalation to CMS requesting national coverage guidance that supersedes the LCD.

Timeline? LCD challenges typically take 6-18 months from initial opposition to resolution. During that period, the LCD remains in effect unless the MAC voluntarily pauses implementation.

For patients, that means coverage restrictions apply now, regardless of ongoing advocacy. Your best bet: Stay informed through ASA updates and work closely with your physician on documentation if your treatment gets denied.

Bottom Line

This LCD fight matters beyond pain management. It tests whether regional Medicare contractors can restrict coverage without robust evidence, and whether medical societies can successfully push back when they believe patients will be harmed.

For chronic pain patients in the affected region: Stay alert. Work with your doctor to document medical necessity now, before any claim gets filed. Monitor ASA’s advocacy updates for comment deadlines and ways to participate.

The outcome will shape how aggressively MACs pursue coverage restrictions in the future—and whether physician advocacy can counter those efforts effectively. ASA’s got serious resources and motivated members. That gives patients a fighting chance for better coverage decisions.