Epidural Steroid Injections for Pain Management
L39240
Epidural steroid injections (ESIs) are covered for radiculopathy, radicular pain, neurogenic claudication from specified structural spinal pathologies, post-laminectomy syndrome, and acute herpes zoster when supported by history, exam, and concordant imaging, with baseline and follow-up objective pain/function scores recorded. Procedures must use CT or fluoroscopic guidance with contrast (ultrasound allowed if contrast contraindicated), adhere to level and session limits (TFESI ≤2 levels per region, CESI/ILESI ≤1 level), and generally be limited to four sessions per spinal region in a rolling 12 months and not extend beyond 12 months unless strict continuation criteria are documented. Several exclusions apply (eg, nonspecific low back pain, investigational biologics, multiple procedures same session, bilateral CESI/ILESI), and documentation of conservative therapy failure, provider credentialing, and contrast use (or contraindication) is required.
"ESI is reasonable and necessary when history, physical exam, and concordant radiologic image-based diagnostic testing support lumbar, cervical, or thoracic radiculopathy, radicular pain, or neuroge..."