MedicaidCoverageHigh impact
Injections for Chronic Pain Conditions - MEDICAID - ILLINOIS (New)
Humana·IL · Pain Management, Anesthesiology, Orthopedics +1 more·Medicaid
Effective date
May 22, 2026
We identified it
Jun 24, 2026
Summary
New Medicaid policy in Illinois establishing coverage criteria for chronic pain injections including epidural steroid injections, trigger point injections, and nerve blocks. The policy requires 4 weeks of failed conservative treatment and limits injection frequency and locations per session.
Action Required
Before May 22, 2026: Billing team must update prior authorization requirements for Illinois Medicaid chronic pain injection claims (CPT 62321, 62323). Ensure documentation includes 4 weeks failed conservative treatment, radicular pain evidence, and real-time imaging guidance. Update billing system to enforce session limits: maximum 1 nerve root level for caudal/interlaminar approaches, maximum 2 injections for transforaminal approaches. Claims without proper documentation will be denied.