Epidural Steroid Injections for Pain Management

Epidural steroid injections are covered when history, physical exam, and concordant imaging support radiculopathy, radicular pain, neurogenic claudication, post-laminectomy syndrome, or acute herpes zoster, when pain significantly impairs function and pain persists ≥4 weeks despite conservative care. Procedures must use image guidance (CT/fluoroscopy with contrast unless contraindicated), adhere to level and per-session limits (TFESI ≤2 levels, CESI/ILESI ≤1 level), and are limited to ≤4 sessions per spinal region in a rolling 12-month period; continuation beyond 12 months or atypical uses require specific documented justification and provider credentialing.

"ESI is medically reasonable and necessary when history, physical exam, and concordant radiologic imaging support lumbar, cervical, or thoracic radiculopathy, radicular pain, or neurogenic claudicat..."

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