Transforaminal Epidural Injections (CPB 0722, reviewed 2025-10-20)
Summary
Aetna considers diagnostic selective transforaminal epidural steroid injections (TFESIs) with imaging guidance medically necessary for chronic radiculopathy when the diagnosis remains uncertain after standard evaluation, and considers an initial therapeutic TFESI medically necessary when physical therapy and non-narcotic analgesics have failed or become intolerant and the radicular pain is consistent with radiologic findings. Additional therapeutic TFESIs are medically necessary when the initial injection produced at least two of the following for at least 2 weeks: 50% or greater pain relief, increased level of function or physical activity, or reduced pain medication use and/or additional medical care such as physical therapy or chiropractic care. A maximum of twelve TFESIs per spinal region is considered medically necessary, administered during a maximum of three sessions for an episode of pain lasting six months, and TFESI sessions more frequent than every two weeks are considered not medically necessary.
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