CommercialCoverageHigh impact
Epidural Steroid Injections 7.01.115
Excellus BlueCross BlueShield·Orthopedics, Pain Management, Neurosurgery +1 more·Bone & Joints (Orthopedic)
Effective date
Oct 15, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their epidural steroid injection policy effective October 15, 2025, establishing specific medical necessity criteria for diagnostic nerve blocks and therapeutic epidural injections. The policy requires comprehensive pain management programs, specific imaging timeframes, and limits injection frequency to prevent denials.
Action Required
By October 15, 2025: Billing team must update prior authorization processes to verify patients meet all criteria including 4+ weeks conservative treatment, comprehensive pain management program participation (physical therapy, patient education, psychosocial support, oral medications), and advanced imaging within 24 months for cervical/thoracic injections. Providers must document 50%+ pain relief for repeat injections and ensure 14+ day intervals between sessions. Update encounter forms to capture required documentation elements to prevent claim denials.