Billing and Coding: Epidural Steroid Injections for Pain Management

This policy provides billing and coding guidance specific to epidural steroid injections (ESIs) for pain management, limited to cervical/thoracic and lumbar/sacral epidural procedures with specified CPT codes. It imposes utilization limits (one spinal region per session, level limits per code, and a maximum of four sessions per spinal region in a rolling 12 months), requires detailed medical record documentation and coding modifiers (-50, -RT/-LT, -KX) for certain scenarios, and disallows non‑FDA injectants and routine use of deeper sedation or use of epidural codes for chemotherapy.

"Epidural steroid injections (ESIs) are covered when performed as epidural injections in defined anatomic spinal regions: cervical/thoracic or lumbar/sacral using the listed epidural CPT codes."

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