CMM-404: Epidurography

Epidurography (CPT 72275) is medically necessary for initial or subsequent mapping of the epidural space only when the patient’s medical/surgical history suggests significantly abnormal epidural anatomy and diagnostic mapping beyond CT/MRI is required to plan a therapeutic procedure (subsequent mapping also requires a clinically significant anatomical change); it is not medically necessary when used solely to determine needle placement or when contrast is injected during an image‑guided epidural steroid injection. Key requirements: the study must include fluoroscopic guidance, permanent multi‑plane images and a separate formal radiologic report documenting epidural fluid flow and anatomic findings (e.g., scarring or nerve impingement), and the epidurography report must be distinct from any therapeutic procedure report.

"Epidurography for initial mapping of the epidural space is considered medically necessary when both of the following are met: Medical/surgical history suggests significantly abnormal anatomy of the..."