CMM-200: Epidural Steroid Injections (ESI)

Diagnostic selective nerve root blocks (SNRBs) using anesthetic only and therapeutic epidural steroid injections (transforaminal, interlaminar, caudal) are covered for specified radiculopathy/radiculitis and selected spinal stenosis indications, while SNRBs with non‑approved injectates, repeat/therapeutic same‑level SNRBs, ESIs without CT/fluoroscopy guidance or with ultrasound, ESIs for axial pain or post‑herpetic neuralgia, and procedures exceeding level/frequency limits are excluded or investigational. Key requirements include documented level‑specific neurologic findings (within 3 months), concordant MRI/CT or EMG within 12 months (24 months for cervical/thoracic repeats), prior conservative therapy (≥6 weeks for radiculopathy/radiculitis, ≥4 weeks for stenosis), fluoroscopic/CT guidance with contrast, injectates limited to anesthetic/corticosteroid/contrast, limits on levels per session (TFESI ≤2 levels, ILESI single level), repeat criteria (≥7 days for diagnostic SNRB repeats with <80% prior relief and multilevel pathology), and frequency limits of ≤3 ESIs per region per 6 months (≤4 per 12 months) with ≥14 days between injections.