Utilization Review Checklist
Meralgia Paresthetica
Derived from the ACOEM Hip and Groin Disorders Guideline, edition 29 January 2026, as adopted into the California MTUS 1 August 2026. CPT 64712, 64722. ICD-10 G57.1.
Draft — not reviewed or approved by COA. Prepared by Rette from the ACOEM guideline named above. This is not a COA document and does not reproduce COA’s own checklists.
CriteriaCheck if documented
Confirmatory Diagnosis
Required
Diagnosis and site of entrapment confirmed by nerve conduction study or MR neurography
“Should have diagnosis and site of entrapment confirmed by either nerve conduction study or MR neurography.” — p. 289
Conservative Care
Required
Continued symptoms unresponsive to prior treatments, sufficiently severe to warrant invasive treatment
“Indications Patients who both have continued symptoms unresponsive to the above treatments and in whom symptoms are sufficiently severe to warrant invasive treatment.” — p. 289
Surgical Considerations (surgical release)
Required
Release requested for a select patient
“Surgical release is recommended for treatment of select patients with meralgia paresthetica.” — p. 289
Procedures — the guideline treats each separately
Surgical release for meralgia paresthetica
Recommended.
Strength of Evidence — Recommended, Insufficient Evidence (I) · confidence moderate
One requirement here is easy to miss and hard to retrofit: the diagnosis AND THE SITE OF ENTRAPMENT must be confirmed by either a nerve conduction study or MR neurography. A clinical diagnosis alone does not meet it. Arrange the study before filing.