CommercialCoverageHigh impact
Policy Criteria Changes
Arkansas Blue Cross Blue Shield·AR · Pain Management, PM&R (Physical Medicine & Rehab), Orthopedics +2 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Arkansas Blue Cross updated coverage criteria for epidural steroid injections (ESI) for back pain, requiring specific pain duration, intensity scores, failed conservative care, and objective findings. ESIs are limited to 4 sessions per spinal region in 12 months with detailed documentation requirements.
Action Required
By January 1, 2026: Update prior authorization requirements for epidural steroid injections to require VAS pain score ≥5 or moderate ODI disability, 4+ weeks pain duration, failed conservative care documentation, and objective radiculopathy findings. Limit to 4 sessions per spinal region per 12 months. Train providers on new documentation requirements including contrast injection confirmation and fluoroscopy imaging retention. Update billing system to track injection frequency limits.