CurrentCareSourcePolicy Epidural Steroid Injections-AR PASSE-MM-1504

Epidural Steroid Injections

Defines medical necessity criteria, limitations, exclusions, and procedural billing components for epidural steroid injections (translaminar/interlaminar, transforaminal, caudal) for chronic back pain for Arkansas PASSE members under CareSource.

Policy Summary

PayerCareSource

PolicyEpidural Steroid Injections

Policy CodePolicy Epidural Steroid Injections-AR PASSE-MM-1504

Change TypeReviewed/Updated; exemption added

Effective DateMar 1, 2026

Next Review Date

Key ActionDocument at least 6 weeks of active and 6 weeks of inactive conservative therapy within the past 6 months or document inability to complete active therapy; submit prior authorization and device interrogation reports when applicable.

SourceLink

POLICY UPDATE CHANGES

Policy reviewed/updated multiple times; Effective Date set to 03/01/2026 with prior reviews noted (01/31/2024, 01/15/2024, 12/03/2025).

Explicit statement that epidural steroid injections for labor and delivery or post-surgical pain do not require medical necessity review.

6Maximum injections per 12 months

3Max procedures per 12 weeks per region

2Max diagnostic injections (initial)

>=50%Required relief from prior injection to permit subsequent