Date Printed: May 21, 2018: 08:25 PM

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Subject: Epidural Injections

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This medical coverage guideline is not an authorization, certification, explanation of benefits, or a guarantee of payment, nor does it substitute for or constitute medical advice. All medical decisions are solely the responsibility of the patient and physician. Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. This medical coverage guideline applies to all lines of business unless otherwise noted in the program exceptions section.



Epidural injections may help manage some types of moderate to severe neck or back pain caused by nerve irritation. Examples include bone pressing on a nerve or a damaged disk in the spine. Several types of epidural injections are available. The type used depends on the location and cause of the pain. Epidural injections may be given in the neck or upper or lower back. The treatment is often administered in an outpatient setting.

In an epidural injection, your doctor inserts a long needle into the space between the bones in the spine and the spinal cord. Using an xray device called a fluoroscope, or another imaging device such as a CT scanner, the needle is guided to the base of the irritated nerve. Your doctor then injects medicine to block the pain and reduce swelling.

After first taking your medical history and examining you, your doctor will evaluate you for treatment. Your doctor may first try other more conservative treatments to relieve your pain. If these do not work, your doctor may then try epidural injections.

Typically, you first receive one to two injections to see if they relieve your pain. If your pain improves, you may receive additional injections over time. Your doctor will continue to measure your improvement.

Visit the Clinical View of this guideline for more information.

Visit WebMD for more information on using epidural injections to treat neck or back pain.



Note: For all medical decisions about this service, Florida Blue uses the Position Statement in the Clinical View of this medical coverage guideline. To make the best decision for your health needs, talk to your doctor. The services covered vary from health plan to health plan. Refer to your health plan contract for complete information about your coverage.


Epidural injections may meet the definition of medical necessity for the following conditions:

• severe acute cervical or lumbar radiculopathy

• chronic cervical or lumbar radiculopathy

• an acute infection of herpes zoster

• post herpetic neuralgia


• Federal Employee Program (FEP): Certain exceptions apply.

• State Account Organization (SAO): Certain exceptions apply.

• Medicare Advantage products: Certain exceptions apply.

Visit the Clinical View of this guideline for more coverage information.

Refer to your health plan contract for complete information about your coverage.

Date Printed: May 21, 2018: 08:25 PM