Selective Nerve Root Blocks and Transforaminal Epidural Steroid Injections

This policy covers selective nerve root blocks (SNRBs) and transforaminal epidural steroid injections (TFESIs) for diagnosis and treatment of radicular pain—acute (<3 months) or chronic (≥3 months)—including pain from disc herniation or spinal stenosis that substantially interferes with activities of daily living. Coverage requires documented failure of conservative therapy (≥4 weeks PT/chiropractic/home exercise, ≥3 weeks NSAID or documented contraindication/intolerance, ≥4 weeks activity modification), appropriate neurologic/imaging/electrodiagnostic evaluation, performance by a physician with real-time radiographic guidance, limits on levels treated and procedures per visit, cervical TFESIs must use non-particulate steroid, diagnostic SNRBs are limited to one, and repeat injections require specified intervals and justification.

"Transforaminal epidural steroid injections (TFESIs) as an alternative to interlaminar epidural steroid injections for treatment of radicular pain."