Epidural Steroid Injections for Pain Management
L38994
Epidural steroid injections (ESIs) are covered for radiculopathy, neurogenic claudication from specified spinal pathology, post-laminectomy syndrome, and refractory acute herpes zoster when history, exam, and concordant imaging document the indication, symptoms significantly impair function, and at least 4 weeks of conservative care has failed (except herpes zoster). Procedures must be image-guided (CT/fluoroscopy with contrast unless contraindicated), adhere to level and session limits (TFESI ≤2 levels per region, CESI/ILESI ≤1 level), and follow documentation requirements including baseline and follow-up using the same validated pain/function scale; overall use is limited to 4 sessions per spinal region in a rolling 12-month period and generally should not extend beyond 12 months without specific justification.
"ESI is medically reasonable and necessary when history, physical examination, and concordant radiologic image-based diagnostic testing are documented and support treatment for radiculopathy, radicu..."