MedicaidCoverageHigh impact
Injections for Chronic Pain Conditions - MEDICAID - VIRGINIA (Revised)
Humana·VA · Pain Management, Anesthesiology, Neurosurgery +2 more·Medicaid
Effective date
May 27, 2026
We identified it
Jun 24, 2026
Summary
This is a revised Virginia Medicaid policy for chronic pain injection procedures, effective May 27, 2026. The policy outlines specific coverage criteria for epidural steroid injections, requiring 4 weeks of failed conservative treatment, radicular pain, and limits on the number of injections per session with mandatory imaging guidance.
Action Required
Before May 27, 2026: Billing team must update prior authorization requirements for Virginia Medicaid chronic pain injection claims (CPT 62321, 62323). Ensure documentation includes 4 weeks of failed conservative treatment, radicular pain evidence, and imaging guidance verification. Update encounter forms to remind providers of session limits: caudal/interlaminar limited to 1 nerve root level per session, transforaminal limited to 2 injections per session. Claims without proper documentation will be denied.