CMM-200: Epidural Steroid Injections (ESI)

Epidural steroid injections (transforaminal, interlaminar, caudal) and diagnostic selective nerve root blocks (anesthetic only) are medically necessary for radiculopathy/radiculitis or symptomatic spinal stenosis when supported by a concordant neurologic exam and imaging/electrodiagnostic findings, and therapeutic ESI requires failure of a minimum four‑week conservative trial or SNRB when diagnosis remains uncertain after standard evaluation. Key requirements/limits: fluoroscopic guidance with contrast is required (except emergent/contraindicated) and ultrasound is experimental; ESI for axial pain without radiculopathy/myelopathy is excluded; no more than 3 injections per episode and 4 per region per year with limits on levels per session (≤2 TF, ≤1 IL), catheter infusions limited to inpatient use, caudal ESI above L4‑L5 needs specific rationale, and repeat injections require documented ≥50% pain relief and functional improvement plus specified recent exam/imaging/EMG documentation.