Description
Epidural injections are generally performed to treat pain arising from spinal nerve roots. These procedures may be performed via three distinct techniques, each of which involves introducing a needle into the epidural space by a different route of entry. These are termed the interlaminar, caudal, and transforaminal approaches. The procedures involve the injection of a solution containing local anesthetic with or without corticosteroids. In order to be considered medically necessary, they must meet certain indications and procedural requirements.
Affected Code(s)
64483, 64484
Applicable Policy References
1. SSA, Title XVIII- Health Insurance for the Aged and Disabled, Section 1862(a)(1)(A)- Exclusions from Coverage and Medicare as a Secondary Payer
2. SSA, Title XVIII- Health Insurance for the Aged and Disabled, Section 1833(e)- Payment of Benefits
3. 42 CFR §405.929- Post-Payment Review
4. 42 CFR §405.930- Failure to Respond to Additional Documentation Request
5. 42 Code of Federal Regulations (CFR) §405.980- Reopening of Initial Determinations, Redeterminations, Reconsiderations, and Reviews (b)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Initiated by a Contractor; and (c)- Timeframes and Requirements for Reopening Initial Determinations and Redeterminations Requested by a Party
6. 42 Code of Federal Regulations (CFR) §405.986- Good Cause for Reopening
7. Medicare Program Integrity Manual, Chapter 3- Verifying Potential Errors and Taking Corrective Actions, §§3.1- 3.6.6
8. Noridian Healthcare Solutions, LLC (JF), Local Coverage Determination; L34980 Lumbar Epidural Injections; Effective: 10/01/2015; Retired 06/23/2022
9. Noridian Healthcare Solutions, LLC (JE), Local Coverage Determination; L34982 Lumbar Epidural injections; Effective: 10/01/2015; Retired 06/20/2022
10. Noridian Healthcare Solutions, LLC (JE), Local Coverage Article; A57202 Billing and Coding: Lumbar Epidural Injections; Effective 10/01/2019; Retired 6/20/2022
11. Noridian Healthcare Solutions, LLC (JF), Local Coverage Article; A57203 Billing and Coding: Lumbar Epidural Injections; Effective 10/01/19; Retired 6/20/2022
12. Noridian Healthcare Solutions, LLC (JE), Local Coverage Determination; L39240 Epidural Steroid Injections for Pain Management; Effective: 06/19/2022
13. Noridian Healthcare Solutions, LLC (JF), Local Coverage Determination; L39242 Epidural Steroid Injections for Pain Management; Effective: 06/19/2022
14. Noridian Healthcare Solutions, LLC (JE), Local Coverage Article; A58993 Billing and Coding: Epidural Steroid Injections for Pain Management; Effective 06/19/2022; rev. 11/06/2022
15. Noridian Healthcare Solutions, LLC (JF), Local Coverage Article; A58995 Billing and Coding: Epidural Steroid Injections for Pain Management; Effective 06/19/2022; rev. 11/06/2022
16. Novitas Solutions, Inc. (JL & JH), Local Coverage Determination; L36920 Epidural Injections for Pain Management; Effective: 05/04/2017; Revised 12/12/2021
17. Novitas Solutions, Inc. (JH & JL), Local Coverage Article; A56681 Billing and Coding: Epidural Injections for Pain Management; Effective: 7/11/2019; Revised 12/12/2021