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Excellus BlueCross BlueShieldCommercial · Coverage · Bone & Joints (Orthopedic) · NY · Orthopedics, Pain ManagementMedium impact

Epidural Steroid Injections - (Effective Date - 2026-10-15) 7.01.115

Effective date
Oct 15, 2026
Identified
Jul 16, 2026

Summary

Excellus BlueCross BlueShield medical policy 7.01.115 on epidural steroid injections (ESIs) and selective nerve root blocks (SNRBs) has a current effective date of October 15, 2026. Initial ESIs are considered medically appropriate for presumed radiculopathy or radicular pain after at least four weeks of conservative treatment, participation in a comprehensive pain management program, and level-specific neurologic findings, with advanced imaging within the past 24 months required for cervical/thoracic interlaminar and transforaminal ESIs. Repeat ESIs require at least 14 days since the prior injection and documented pain relief of at least 50% for at least two weeks, and ESIs are limited to three sessions per episode of pain per region in six months and four sessions per region in a rolling 12 months. ESIs performed with ultrasound guidance or with injectates other than anesthetic, corticosteroid, and/or contrast agent are considered investigational.

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What to do

Action · 6 steps
01Already effective October 15, 2026: Billing team should confirm that every ESI and SNRB claim documents fluoroscopic or CT guidance, since ESIs performed without imaging guidance are considered not medically necessary except in an emergent situation or when guidance or contrast is contraindicated (e.g., pregnancy).
02Confirm that only one invasive modality or procedure is billed on the same date of service, except a transforaminal ESI performed with a synovial cyst aspiration together with an intra-articular facet joint injection.
03Confirm that interlaminar or caudal ESIs are billed for one spinal level per session, that a diagnostic SNRB is billed for one single level and side per session, and that caudal ESIs are billed only for symptomatic levels below L4-L5.
04For cervical or thoracic interlaminar and transforaminal ESIs, the chart needs advanced imaging (MRI, CT, or CT myelogram) within the past 24 months.
05Before ESIs are billed for radiculopathy or radicular pain, the chart needs documentation of at least four weeks of failed conservative treatment and of participation in a comprehensive pain management program that includes physical therapy, patient education, psychosocial support, and oral medications.
06Repeat ESIs are considered not medically necessary when they are scheduled as a series-of-three without evaluation of response to the prior injection, when more than three sessions per episode of pain per region occur in six months, or when more than four sessions per region occur in a rolling 12 months.

Codes mentioned

623206232162322623236232462325623266232764479644806448364484

Original notice

Epidural Steroid Injections - (Effective Date - 2026-10-15) 7.01.115
excellusbcbs.com · Always check the source before changing claims.
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Related changes

See all Excellus BlueCross BlueShield changes →
Interventional Pain Management for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.122MediumEffective Jan 1, 2027 · Bone & Joints (Orthopedic)Epidural Steroid Injections 7.01.115MediumNo effective date · Bone & Joints (Orthopedic)Browse every Excellus BlueCross BlueShield change in the policy list

Related policy hubs

Excellus BlueCross BlueShield policiesNY policy changesOrthopedicsPain ManagementCode 62320Code 62321Code 62322Code 62323Code 62324Code 62325Code 62326Code 62327Code 64479Code 64480Code 64483Code 64484

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