CMM-200: Epidural Steroid Injections (ESI)

Covers diagnostic SNRBs (anesthetic-only) and therapeutic ESIs (transforaminal, interlaminar, caudal) for specified radicular/radiculitis/radiculopathy indications and excludes investigational or non‑supported uses (e.g., therapeutic/repeat SNRBs, ESIs without fluoroscopic/CT guidance or done with ultrasound, ESIs for isolated axial pain or post‑herpetic neuralgia, inappropriate injectates, TFESI/SNRB at >2 levels in one session, caudal ESI above L4‑L5 without rationale). Key requirements: documented failure of conservative care (generally ≥6 weeks for radiculopathy, ≥4 weeks for spinal stenosis trial), concordant advanced imaging or electrodiagnostic evidence within specified timeframes, procedure under fluoroscopy/CT with contrast, limits of ≤3 ESIs per region per 6 months (≤4 per 12 months) with minimum intervals (≥7 days for repeat diagnostic SNRB; ≥14 days for repeat ESI), and patient participation in an active rehabilitation program.

"The use of an indwelling catheter to administer a continuous infusion/intermittent bolus should be limited to use in a hospital setting only (procedural limitation)."