CMM-200: Epidural Steroid Injections

Coverage: Diagnostic single‑level selective nerve root blocks and therapeutic epidural steroid injections (interlaminar, caudal, transforaminal) using anesthetic/corticosteroid ± contrast under fluoroscopic or CT guidance are medically necessary when criteria are met; biologic injectates (e.g., PRP, stem cells), ultrasound‑guided procedures, therapeutic repeat SNRBs, and injections for non‑radicular/axial pain or post‑herpetic neuralgia are excluded or considered experimental/not medically necessary. Key requirements: Prior ≥4 weeks conservative care and participation in a comprehensive pain management program, concordant neurologic exam (within 3 months) or imaging/EMG correlation (imaging within 24 months for specified indications), adherence to frequency/level limits (e.g., ≤3 sessions per episode and ≤4 per region per 12 months; TFESI ≤2 contiguous levels; single‑level SNRB), mandatory fluoroscopic/CT with contrast, and timing/relief documentation for repeats (≥14 days and ≥50% relief for repeat ESI; ≥7 days and <80% relief prerequisites for additional diagnostic SNRBs).