Transforaminal Epidural Injections

Aetna covers diagnostic TFESIs with fluoroscopic or CT guidance to establish radiculopathy when standard evaluation is inconclusive and covers an initial therapeutic image‑guided TFESI for radiculopathy after failure or intolerance of conservative noninvasive measures and when symptoms are consistent with imaging. Key limits: TFESIs are not medically necessary at >2 contiguous vertebral levels or >4 injections in a single session, no more than 3 sessions per spinal region per 6 months (maximum 12 injections across up to 3 sessions per 6‑month episode), no more than 4 sessions per region per 12 months, and sessions must be ≥2 weeks apart.

"To establish the diagnosis of radiculopathy, when pain appears to be due to classic mono-radiculopathy but radiological or neurodiagnostic studies fail to provide a structural explanation."

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