Epidural Steroid Injections for Pain Management
L39015
Epidural steroid injections are covered when history, physical exam, and concordant imaging confirm radiculopathy, radicular pain, or neurogenic claudication from specific structural spinal pathologies, for post-laminectomy syndrome, or for acute herpes zoster pain, provided objective baseline and follow-up functional/pain scales are documented and at least four weeks of conservative therapy has failed (except for specified herpes zoster cases). Procedures must use CT or fluoroscopic guidance with contrast (ultrasound without contrast only if contrast is contraindicated), adhere to level and per-session limits (TFESI ≤2 levels, CESI/ILESI ≤1 level), and meet frequency limits (maximum four sessions per spinal region in a rolling 12 months); continuation beyond 12 months and use of non‑standard agents or approaches is restricted and requires additional documentation and justification.
"ESI is medically reasonable and necessary when history, physical examination, and concordant radiological imaging support lumbar, cervical, or thoracic radiculopathy, radicular pain, or neurogenic ..."