Injections for Chronic Pain Conditions - MEDICAID - VIRGINIA

This Humana Medicaid (VA) policy defines coverage criteria for several injections used in chronic pain management: epidural steroid injections, ganglion impar blocks, sacroiliac joint injections, and trigger point injections. Coverage is conditional on specified conservative care failures, documented diagnostic/therapeutic responses (including minimum percent pain relief and durations), limits on frequency and number of injections per rolling 12-month period, and required use of real-time imaging guidance; numerous injections and techniques (eg, genicular artery embolization, various peripheral nerve blocks, ultrasound guidance for many procedures, MAC/general anesthesia in adults) are explicitly considered not medically necessary.

"Epidural steroid injections performed at multiple nerve root levels (in excess of the maximum number outlined in the Coverage Determination section) OR at multiple anatomical regions during the sam..."