CMM-200: Epidural Steroid Injections

Covered: diagnostic single‑level selective nerve root blocks and therapeutic epidural steroid injections (interlaminar, caudal, transforaminal — including TFESI with synovial cyst aspiration when imaging confirms cyst compression) are medically necessary when criteria are met; excluded are epidural anesthesia/perioperative epidurals, non‑approved injectates (e.g., PRP, chemotherapeutics, biologics), ESIs performed without imaging/contrast, TFESIs >2 contiguous levels or interlaminar ESIs at >1 level in the same session, and other listed procedural limitations. Key requirements: concordant neurologic exam plus MRI/CT within 24 months or EMG/NCV as applicable, failure of ≥4 weeks conservative therapy for therapeutic ESIs, SNRB only if diagnosis remains uncertain after standard evaluation, repeat ESI only with ≥50% pain relief for ≥2 weeks plus functional/medication improvement, use of fluoroscopic/CT guidance with contrast (unless contraindicated), ≥14 days between injections, and a maximum of 3 ESIs per region per 6 months (≤4 per 12 months).