Nerve Block denials at external review

• concentrated

  53% of these disputes involved orthopedic & musculoskeletal alone (n=76, 61.8% overturned), so the headline figure for nerve block is largely that pairing.

California requires each published decision to carry “a detailed case summary that includes the specific standards, criteria, and medical and scientific evidence, if any, that led to the case decision” (Health & Safety Code § 1374.33(h)(1)(K)). These are the elements our extraction found in this class, split by how the decision came out.

Read as description, not instruction. These are patterns in what reviewers wrote, not steps to follow, and no combination of them predicts an outcome. Only codes that cleared the validation gate appear — thirteen did not.

• American Headache Society—4
• FDA—3
• American Academy of Neurology—1

A rate here is the outcome of decisions that named the authority, not the effect of naming it. Reviewers cite the standard they applied; the citation and the outcome share a cause.

• Orthopedic & musculoskeletal61.8%76
• CNS & neuromuscular80.0%60
• Ear, nose & throat—1
• Foot—1
• Genitourinary & kidney—1
• Immune disorders—1
• Mental health—1
• Post-surgical complications—1

Browse all condition classes · Pick your own pair

• Back Pain—27
• Migraine—25
• Headache—16
• Other—14
• Knee Problem/Pain—11
• Neck Problem/Pain—10
• Osteoarthritis—8
• Vertebral Disc Prob—8

• Experimental/Investigational73.9%92
• Medical Necessity64.7%51

Medical-necessity review asks whether the care is needed. Experimental/investigational review asks whether it is likely to be more beneficial than standard therapy — a harder statutory test, and the rates show it.