← Back to list
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) 7.01.122
Effective date
Jan 1, 2027
Identified
Oct 6, 2026
Summary
Excellus BlueCross BlueShield's new medical policy 7.01.122 takes effect January 1, 2027 and covers interventional pain management for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) members. It sets criteria for epidural steroid injections, selective nerve root blocks, facet joint injections and medial branch blocks, radiofrequency neurolysis, and sacroiliac joint injections. Each procedure is considered medically appropriate only when all of its listed criteria are met, and is considered not medically necessary when any listed contraindication applies.
Get alerts when payers change rules like this one
We check Excellus BlueCross BlueShield and other payers every day and email you when a change matches your specialty and state.
Get Excellus BlueCross BlueShield alertsPolicy Monitoring is free. No card required.
What to do
Action · 8 steps
01Effective January 1, 2027: Claims for epidural steroid injections (CPT 62320, 62321, 62322, 62323, 64479, 64483) need documentation of a diagnosis of degenerative lumbar spondylolisthesis with associated neurological findings, failed back surgery syndrome or epidural fibrosis, or spinal stenosis, with radicular pain that causes functional impairment.
02That documentation also needs at least 6 weeks of chiropractic care or supervised physical therapy, plus medication directed at the underlying disease process or oral analgesics, during the previous 6 months that failed or was not tolerated, and the injection must be performed under CT or fluoroscopic guidance.
03Repeat diagnostic epidural injections are limited to two in total, at least 2 weeks apart, and repeat therapeutic injections are limited to four per spinal region per year, at least 10 weeks apart, with the previous injection giving at least 50% pain reduction lasting 10 weeks.
04Diagnostic selective nerve root blocks need anesthetic-only injectate, documentation that clinical findings suggest nerve root pathology or that the block is for preoperative planning, and a completed evaluation with a neurological exam, electrodiagnostic testing, or relevant imaging.
05Claims for facet joint injections or medial branch blocks (CPT 64490, 64493, 0213T, 0216T) need documentation of pain persisting at least 12 weeks that limits activities of daily living and is non-radicular, at least 6 weeks of conservative management, and image guidance by CT, fluoroscopy or ultrasound.
06Radiofrequency neurolysis (CPT 64633, 64635) needs documentation that no alternative pain generator is present, pain persisting at least 3 months, and significant reduction after no more than two diagnostic facet joint or medial branch blocks, and repeat radiofrequency procedures are limited to two per spinal region in a 12-month period and at least 6 months after the previous procedure at the same level.
07Sacroiliac joint injections (CPT 27096, 64451, HCPCS G0260) need documentation of at least one positive provocative test, unilateral non-radicular pain below the L5 level persisting at least 3 months, at least 6 weeks of conservative management, and CT or fluoroscopic guidance.
08Services for a listed contraindication, such as an allergy to any component of the injectate, active infection, uncontrolled bleeding or clotting disorder, or pregnancy, are considered not medically necessary.
Codes mentioned
623206232162322623236447964483644906449364633646352709664451G0260
Original notice
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) 7.01.122
excellusbcbs.com · Always check the source before changing claims.
Related changes
See all Excellus BlueCross BlueShield changes →Epidural Steroid Injections - (Effective Date - 2026-10-15) 7.01.115MediumEffective Oct 15, 2026 · Bone & Joints (Orthopedic)Radiofrequency Facet and Sacroiliac Joint Ablation/ Denervation - (Effective Date - 2026-10-15) 7.01.42MediumEffective Oct 15, 2026 · Bone & Joints (Orthopedic)Facet Joint Injections/ Medial Branch Blocks - (Effective Date - 2026-10-15) 7.01.116MediumEffective Oct 15, 2026 · Bone & Joints (Orthopedic)Browse every Excellus BlueCross BlueShield change in the policy list