Billing and Coding: Epidural Steroid Injections for Pain Management
A56651
This policy provides billing and coding guidance for epidural steroid injections (ESIs) per LCD L33906, specifying allowed CPT codes and procedural distinctions (caudal/interlaminar vs transforaminal) and requiring -KX for diagnostic selective nerve root blocks. Coverage/exemptions include postoperative acute pain diagnoses (G89.12, G89.18), infusion pump trials for severe spasticity per NCD 280.14, and cisternography (CPT 78630); non‑FDA injectants (e.g., amniotic tissue, PRP, vitamins) risk claim denial. Utilization limits include one spinal region per session, level and per-session limits (max two levels for TFESI codes; one level for 62321/62323), and a maximum of four sessions per anatomic region in a rolling 12-month period, with detailed documentation requirements.
"Epidural steroid injections (ESIs) for pain management are covered when reasonable and necessary per Local Coverage Determination L33906."