Submitting Epidural Steroid Injection (ESI) Requests

Clinical Background

Steroid injections can happen in any section of the spine; however, they are most common in the lumbar region, which is in the low back.  Each bone within the spine is known as a vertebra. 

There are two types of epidural steroid injections that are most common and require pre-authorization through Cohere: interlaminar and transforaminal. 

  1. Interlaminar injection: Delivered into the space between two vertebrae. Since this injection is not targeted to one specific nerve, the steroid will travel throughout the entire lumbar region, meaning it will have a more widespread effect on pain. 
  2. Transforaminal injection: Targeted to a specific nerve or nerves. Before a patient receives a transforaminal injection, it is common for the patient to have an MRI prior to the injection, so the nerve causing pain can be identified. This injection both helps pain, as well as confirms which nerve is the cause of pain. 

What will auto-approve?

  • A patient’s total injections should not exceed a total of 3, inclusive of initial and subsequent treatment, in the same region within 6 months.
  • Due to the type of injection and efficacy, more than one interlaminar injection will pend for review. For transforaminal injections, non-adjacent levels or more than two adjacent levels will pend for review.

What to include with your request

Initial requests Subsequent requests

The request must meet the following criteria: 

  • Medical necessity
  • One authorization request per episode of pain, per region. 
  • The patient has had 2 or fewer epidural steroid injections for the same region within the past 6 months.
  •  
  • Requests must meet the same criteria as listed above and if the patient has had greater than or equal to 2 injections, must: 
    • Demonstrate a 50% reduction in pain and/or symptoms for at least 3 months.

Patient-Reported Outcome Measures (PROMs)

Cohere recommends the use of standardized, evidence-based tools endorsed by the American Academy of Orthopaedic Surgeons (AAOS) for the assessment of a patient’s functional disability.  Click here to access these tools.

Oswestry Low Back Pain Disability Index (ODI)

Used when patients present with symptoms in the lumbar region.

Neck Disability Index (NDI)

Used when patients present with symptoms in the cervical region.

 

Have more questions?
Submit a request