Epidural Steroid Injections for Pain Management

Epidural steroid injections are covered for documented lumbar, cervical, or thoracic radiculopathy, radicular pain, neurogenic claudication from specified structural pathology, post-laminectomy syndrome, and acute herpes zoster when history, exam, and concordant imaging support the diagnosis, pain has lasted ≥4 weeks (except herpes zoster), and baseline objective pain/function scales and conservative-therapy failure are documented. Procedures must be image-guided (CT/fluoroscopy with contrast unless contraindicated), follow level and session limits (TFESI ≤2 levels per region, caudal/ILESI ≤1 level), and are limited to a maximum of four sessions per spinal region in a rolling 12 months; repeat and extended use require documented clinical benefit (≥50% sustained improvement or 50% functional gain) and specific documentation. Contraindications, investigational uses (e.g., non-FDA biologics, non-radicular/axial pain syndromes), provider credentialing, and documentation requirements must be met for coverage.