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Epidural steroid injection medical policy reminder
December 7, 2021

This article is for orthopedic surgeons, rehabilitation facilities, and rheumatology providers who administer epidural steroid injections

We cover epidural steroid injections for neck and back pain as outlined in our existing medical policy 690: Epidural Steroid Injections for Neck and Back Pain.

Epidural steroid injections performed with fluoroscopic guidance may be considered medically necessary for the treatment of neck and back pain when the following criteria are met:

  • Lumbar or cervical radiculopathy (sciatica) that is not responsive to at least four weeks of conservative management
  • Persistent pain is present of at least moderate-severe intensity
  • Short-term relief of pain is the anticipated outcome

Conservative nonsurgical therapy for at least four weeks should include the following:

  • Use of prescription strength analgesics, which include anti-inflammatory medications with or without adjunctive medications such as nerve stabilizers or muscle relaxants, at a dose sufficient to induce a therapeutic response
  • Participation in at least four weeks of physical therapy (including active exercise) or documentation of why the patient could not tolerate physical therapy
  • Evaluation and appropriate management of associated cognitive and behavioral issues

Repeat treatment of persistent pain due to radiculopathy (sciatica) may be considered medically necessary under the following conditions:

  • Previous epidural steroid injections were successful at relieving pain
  • At least 30 days have passed since the last injection
  • No more than six injections are given over a 12-month period.

Payment policy application

  • Enforcement of this medical policy occurs through system edits and post-payment reviews.
  • We continually expand our ability to process claims in accordance with this policy pre-payment, which will reduce the number of claims we review post-payment.


The codes and diagnoses listed in medical policy 690: Epidural Steroid Injections for Neck and Back pain, will be updated on our website in January 2022. To download this medical policy, please visit our medical policy site.