CMM-200: Epidural Steroid Injections (ESI)

Covered: single‑level diagnostic selective nerve root blocks (anesthetic only) for uncertain radicular diagnoses in specified clinical scenarios, and therapeutic epidural steroid injections (TFESI, ILESI, CESI) for radiculopathy after failed conservative care, radiculitis with dermatomal findings and positive provocation tests, symptomatic spinal stenosis with confirmatory imaging, and TFESI with synovial‑cyst aspiration when imaging shows nerve‑root compression; excluded are ESIs for axial (non‑radicular) pain, ultrasound‑guided ESIs, injections without fluoroscopic/CT guidance/contrast, TFESI/SNRB at >2 nerve‑root levels per session, interlaminar ESIs at multiple levels, same‑day multiple regional spinal injections, and therapies exceeding stated frequency limits. Key requirements: recent neurologic exam with concordant deficits, advanced imaging (MRI/CT) or EMG within 12 months confirming nerve‑root compression, documented failure of conservative therapy (generally ≥6 weeks, ≥4 weeks for stenosis), procedures performed with fluoroscopic/CT guidance and contrast (unless contraindicated), limits of ≤3 ESIs per pain episode and ≤4 per region per year, ≥14 days between injections, and specific criteria for repeat or second‑level SNRB (prior <80% relief, multilevel pathology, ≥7 days).