Epidural Steroid Injections for Pain Management
L36920
Epidural steroid injections are covered for lumbar, cervical, or thoracic radiculopathy/radicular pain and neurogenic claudication from specified structural causes, for post-laminectomy syndrome, and for acute herpes zoster pain refractory to conservative care, provided history, physical, and concordant imaging support the diagnosis and baseline objective pain/function scales are documented. Procedures must use CT or fluoroscopic guidance with contrast (exceptions documented), adhere to level and session limits (TFESI ≤2 levels, ILESI/caudal ≤1 level), be combined with conservative care, and meet frequency limits (maximum four sessions per spinal region per rolling 12 months); repeat and continuation beyond 12 months require documented sustained benefit and specific justification.
"ESI is covered when history, physical exam, and concordant radiologic imaging support lumbar, cervical, or thoracic radiculopathy, radicular pain, or neurogenic claudication due to disc herniation,..."