Billing and Coding: Epidural Steroid Injections for Pain Management

This billing and coding article covers epidural steroid injections (epidural injections only) for pain management per LCD L36920, with specific CPT and coding rules for caudal/interlaminar and transforaminal approaches. Key limitations include prohibition of biological/non-FDA injectants (which may cause claim denial), prohibition of bilateral caudal/interlaminar ESI, and utilization limits of one spinal region per session and a maximum of four epidural sessions per anatomic region in a rolling 12-month period. Documentation must be complete, legible, signed, support ICD-10 and CPT coding, include procedural indications and baseline pain scores, and retain fluoroscopic images (minimum two views).

"Epidural steroid injections (epidural injections only) are covered for pain management when reasonable and necessary per LCD L36920."

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