Epidural Steroid Injections for Pain Management

Epidural steroid injections (interlaminar, transforaminal, caudal) are covered when history, physical exam, and concordant imaging support radiculopathy, radicular pain, neurogenic claudication, post-laminectomy syndrome, or acute herpes zoster pain that significantly impairs function and has failed at least 4 weeks of conservative care. Procedures must use fluoroscopic or CT guidance with contrast (exceptions for contrast allergy or pregnancy), adhere to level and session limits (TFESI ≤2 levels, CESI/ILESI ≤1 level, max 4 sessions per spinal region per rolling 12 months), and include documented baseline and follow-up using the same objective pain/function scale; continuation beyond 12 months requires objective sustained benefit and detailed justification.

"ESI is medically reasonable when history, physical exam, and concordant radiological image-based diagnostic testing support radiculopathy, radicular pain, or neurogenic claudication due to disc her..."