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Epidural Steroid Injections (ESIs) for Pain Management
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Commercial product coverage criteria and coding guidance for epidural steroid injections (interlaminar and transforaminal; cervical, thoracic, lumbar/sacral) when medical criteria in the payer's online authorization tool are met. Applies to participating providers submitting prior authorization for commercial members; Medicare Advantage has a separate policy.
No material clinical or coverage changes in this revision.
Medical Necessity Criteria for Epidural Steroid Injections (Commercial)
Medical necessity for Epidural Steroid Injections (Commercial Products)
Epidural injections are considered medically necessary when the medical criteria in the online authorization tool is met.
ALL of the following
- Patient is covered under Commercial Products (policy applies to Commercial Products only).
- Medical criteria as defined in the payer's online authorization tool are met (prior authorization recommended via the online authorization tool).
Applicable Procedure Codes
| 62320 | Injection(s), diagnostic or therapeutic substance(s), interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance |
| 62321 | Injection(s), diagnostic or therapeutic substance(s), interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (eg, fluoroscopy or CT) |
| 62322 | Injection(s), diagnostic or therapeutic substance(s), interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance |
| 62323 | Injection(s), diagnostic or therapeutic substance(s), interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (eg, fluoroscopy or CT) |
| 64479 | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level |
| 64483 | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level |
Prior Authorization and Documentation Requirements
Meet online authorization tool medical criteria
Clinical documentation that conservative measures have failed and that the specific medical criteria in the payer's online authorization tool are satisfied must be available to justify medical necessity for epidural injections.
Clinical and Policy Context
Epidural steroid injections (ESIs) are used to treat neck or back pain that has not responded to conservative measures. Local steroid injections may improve pain by reducing inflammation and relieving pressure on nerve roots or other structures that may be the origin of pain. This policy governs the use of interlaminar and transforaminal ESIs for Commercial Products (commercial members).
Coverage and medical necessity for ESIs for Medicare Advantage members are addressed in a separate policy; this document applies to Commercial Products only. Prior authorization is recommended via the payer's online authorization tool, and ESIs are considered medically necessary only when the medical criteria in that tool are met.
Defined Terms
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