CMM-200: Epidural Steroid Injections

Epidural steroid injections (interlaminar, caudal, transforaminal) and single‑level diagnostic selective nerve root blocks are covered for radiculopathy/radiculitis or neurogenic claudication when ≥4 weeks of conservative therapy has failed, the patient participates in a comprehensive pain‑management program, and there are concordant neurologic findings and/or advanced imaging or EMG, with procedures performed under fluoroscopic/CT guidance with contrast using only anesthetic, corticosteroid, and/or contrast injectates. Not covered are injections using ultrasound guidance, biologic or other nonapproved injectates, ESIs for axial pain or post‑herpetic neuralgia, diagnostic SNRBs that do not meet criteria or therapeutic/repeat SNRBs at the same level, and all services must meet frequency/level limits and specific timing and documentation requirements (e.g., imaging within 24 months, neuro exam within 3 months, repeat‑injection outcome documentation).

"Selective Nerve Root Block (SNRB) - Initial Level: An initial level diagnostic selective nerve root block (SNRB) is considered medically necessary when ALL of the following criteria have been met: ..."