Billing and Coding: Epidural Steroid Injections for Pain Management
A58731
Epidural steroid injections are covered when reasonable and necessary per LCD L39015; coding must follow the specified CPT mappings by spinal region and the procedural, modifier, and documentation rules in this article. Limitations include one spinal region per day, maximum two levels per session for 6447x/6448x codes (and one level for 62321/62323), no more than four sessions per spinal region in a rolling 12-month period, prohibition of non–FDA-approved biological injectants, and that routine sedation/anesthesia is not routinely reimbursable. Documentation must be comprehensive, signed, support ICD-10/CPT selection, include imaging (minimum two views) showing needle position/contrast flow, and record baseline pain scores and immediate percent relief for SNRBs.
"Epidural steroid injections (ESIs) for pain management are covered when reasonable and necessary per LCD L39015 and supported by the patient's medical record."