Description
Epidural injections are generally performed to treat pain arising from spinal nerve roots. These procedures may be performed via three distinct techniques, each of which involves introducing a needle into the epidural space by a different route of entry. These are termed the interlaminar, caudal, and transforaminal approaches. The procedures involve the injection of a solution containing local anesthetic with or without corticosteroids. In order to be considered medically necessary, they must meet certain indications and procedural requirements.
Affected Code(s)
64483, 64484
Applicable Policy References
1. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)- Exclusions from Coverage and Medicare as a Secondary Payer
2. Social Security Act (SSA), Title XVIII- Health Insurance for the Aged and Disabled, Section 1833(e)- Payment of Benefits
3. 42 CFR §405.929- Post-Payment Review
4. 42 CFR §405.930- Failure to Respond to Additional Documentation Request
5. 42 CFR §405.980- Reopening of Initial Determinations, Redeterminations, Reconsiderations, Decisions, and Reviews, (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
6. 42 CFR §405.986- Good Cause for Reopening
7. Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1- 3.6.6
8. CGS Administrators, LLC, Local Coverage Determination L39015- Epidural Steroid Injections for Pain Management; Effective 12/05/2021; Revised 11/9/2023
9. CGS Administrators, LLC, Local Coverage Article A58731- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective 12/05/2021; Revised 03/13/2025
10. First Coast Service Options, Inc., Local Coverage Determination L33906- Epidural Steroid Injections for Pain Management; Effective 10/01/2015; Revised 12/12/2021
11. First Coast Service Options, Inc., Local Coverage Article A56651- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective 10/03/2018; Revised 11/16/2023
12. National Government Services, Inc., Local Coverage Determination L39036- Epidural Steroid Injections for Pain Management; Effective 12/05/2021; Revised 11/23/2023
13. National Government Services, Inc., Local Coverage Article A58745- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective 12/05/2021; Revised 11/23/2023
14. Noridian Healthcare Solutions, LLC (JE), Local Coverage Determination; L39240 Epidural Steroid Injections for Pain Management; Effective: 6/19/2022
15. Noridian Healthcare Solutions, LLC, Local Coverage Determination L39242- Epidural Steroid Injections for Pain Management; Effective: 6/19/2022
16. Noridian Healthcare Solutions, LLC, Local Coverage Article A58993- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective 6/19/2022; Revised 11/15/2023
17. Noridian Healthcare Solutions, LLC, Local Coverage Article A58995- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective 6/19/2022; Revised 11/15/2023
18. Novitas Solutions, Inc., Local Coverage Determination L36920- Epidural Injections for Pain Management; Effective: 5/4/2017; Revised 12/12/2021
19. Novitas Solutions, Inc., Local Coverage Article A56681- Billing and Coding: Epidural Injections for Pain Management; Effective: 7/11/2019; Revised 11/16/2023
20. Palmetto GBA, Local Coverage Determination L38994- Epidural Steroid Injections for Pain Management; Effective 12/5/2021; Revised 11/16/2023
21. Palmetto GBA, Local Coverage Article A58695- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective 12/5/2021; Revised 11/16/2023
22. Wisconsin Physicians Service, Local Coverage Determination L39054- Epidural Steroid Injections for Pain Management; Effective 12/5/2021; Revised 02/01/2024
23. Wisconsin Physicians Service, Local Coverage Article A58777- Billing and Coding: Epidural Steroid Injections for Pain Management; Effective 12/5/2021; Revised 11/30/2023
24. AMA CPT Codebook