Billing and Coding: Epidural Steroid Injections for Pain Management
A58745
This billing and coding article governs epidural steroid injections (ESIs) and defers to the LCD for reasonable and necessary determinations; it applies only to epidural injections and includes specific CPT coding, modifier, and documentation instructions. Key utilization limits are one spinal region per session, maximum two levels per session for transforaminal codes (64479–64484), one level per session for interlaminar/caudal codes (62321, 62323), and no more than four epidural injection sessions per spinal region in a rolling 12-month period; certain uses (cisternography, postoperative pain, implantable pump trials) are exempt from diagnosis code restrictions. Non–FDA-approved biologic injectants and routine moderate/deep/general anesthesia or MAC are not routinely reimbursable and may cause claim denial, and diagnostic SNRBs must be identified with the -KX modifier.
"Epidural steroid injections (epidural injections) are covered when reasonable and necessary per the associated Local Coverage Determination (LCD)."