Epidural Steroid Injections
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Clinical policy governing the use, clinical evidence, and coding for epidural steroid injections for radicular and spinal pain; affects providers who perform or authorize epidural steroid injections for OrthoNet members.
No material clinical or coverage changes in this revision.
Coverage Criteria for Epidural Steroid Injections
Clinical effectiveness summary
Summary of evidence-based effectiveness from cited reviews:
derived from Smith et al. 2019 systematic review
Limited evidence statements
Evidence limitations for other indications:
evidence weaker and less corroborated
formulation equivalence noted
The CPT codes listed in this policy are provided for reference only and do not by themselves indicate coverage. Coverage determinations are made according to the member's benefit document, which may exclude services even if a CPT code appears in this policy. Providers and payers should confirm benefits and any prior authorization requirements under the member's plan before performing or billing for services.
Procedure Codes and Coding Guidance
| 62320 | Injection(s), diagnostic or therapeutic, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance. |
| 62321 | Injection(s), diagnostic or therapeutic, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (fluoroscopy or CT). |
| 62322 | Injection(s), diagnostic or therapeutic, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance. |
| 62323 | Injection(s), diagnostic or therapeutic, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (fluoroscopy or CT). |
| 64479 | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level. |
| 64480 | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional level. |
| 64483 | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level. |
| 64484 | Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level. |
Provider Responsibilities & Billing Notes
Prior authorization determined by member benefit
Coverage for epidural steroid injections and listed CPT-coded procedures is determined by the member's benefit document; this policy's text does not specify prior authorization requirements. Providers must check the member’s benefit plan for any prior authorization, precertification, or coverage limits before scheduling or performing services.
No step therapy specified
No step therapy or trial-of-therapy requirements are specified in this policy text. Providers should not assume step therapy applies based on this document; verify any utilization management protocols with the member’s benefit.
Coding and documentation: use listed CPT codes and document imaging guidance
When submitting claims, document the procedure using the applicable CPT code(s listed in this policy and include procedure details (level, laterality, imaging guidance) as appropriate; the CPT listing is for reference and may not be all-inclusive.
- Use the exact CPT code that matches the procedure description (e.g., 62321 for interlaminar epidural with imaging guidance; 64483 for lumbar transforaminal single level with imaging guidance).
- If imaging guidance (fluoroscopy or CT) was used, document that in the record and code selection per the listed CPT descriptions.
Coverage contingent on member benefit
Listing a CPT code in this policy does not imply that the service is a covered benefit. Coverage and payment are determined by the member's benefit document; inclusion in this policy is reference only.
Background and Evidence Context
Systematic reviews and meta-analyses support that lumbar transforaminal steroid injections are effective for radicular pain due to lumbar disc herniation, with the 2019 systematic review of 19 studies reporting substantial proportions of patients achieving success defined as ≥50% pain reduction (approximately 63% at 1 month, 74% at 3 months, and sustained rates around 64% at 6 months and 1 year). Evidence for effectiveness in radicular pain due to spinal stenosis is weaker and less well corroborated, with smaller studies reporting success rates in the range of roughly 49%–59%. The review also noted comparable effectiveness between particulate and nonparticulate steroid formulations for lumbar transforaminal injections.
Definitions and Outcome Measures
Conservative Therapy Prerequisites
Frequency Limits & Imaging Guidance
Imaging and Guidance Requirements
Imaging guidance required for specific CPT codes
Several listed CPT codes explicitly require imaging guidance (fluoroscopy or CT) for interlaminar and transforaminal epidural injections; perform and document imaging guidance when using these codes.
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