Procedure billing guide

Epidural Steroid Injection Billing and Coding

Epidural steroid injections (ESIs) are billed with CPT 62321 and 62323 for interlaminar and caudal injections with imaging, and 64479 to 64484 for transforaminal injections by spinal region and level. Imaging guidance is included in these codes. Payers pay for ESIs only when the notes document radicular pain, failed conservative care and, for repeat injections, meaningful relief from the last one.

Updated October 12, 2026

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CPT codes

What are the CPT codes for epidural steroid injections?

Code	Description
62320	Interlaminar epidural, cervical or thoracic, without imaging guidance
62321	Interlaminar epidural, cervical or thoracic, with imaging guidance
62322	Interlaminar or caudal epidural, lumbar or sacral, without imaging guidance
62323	Interlaminar or caudal epidural, lumbar or sacral, with imaging guidance
64479	Transforaminal epidural, cervical or thoracic, single level
+64480	Transforaminal epidural, cervical or thoracic, each additional level
64483	Transforaminal epidural, lumbar or sacral, single level
+64484	Transforaminal epidural, lumbar or sacral, each additional level

Codes shown for reference. Always confirm against the current year’s CPT code set and your payer’s policy.

Billing rules

How do you bill epidural steroid injections?

What does Medicare require for epidural steroid injections?

Medicare's Epidural Steroid Injections for Pain Management LCD covers ESIs for radicular pain and for spinal stenosis with neurogenic claudication. The notes should document the diagnosis, the duration of pain, the conservative care tried before the injection, and a pain and function assessment.

The LCD requires imaging guidance, limits the number of levels treated in one session and the number of sessions per spinal region in a rolling 12 months, and requires documented improvement from the previous injection before it is repeated.

Do epidural steroid injections need prior authorization?

Usually, yes. Most commercial and Medicare Advantage plans require prior authorization for ESIs. Since 2026, Medicare's WISeR model has also required it for traditional Medicare patients in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. We confirm authorization status before every scheduled injection.

How do you code an epidural steroid injection correctly?

Code transforaminal injections per level and per side, adding modifier 50 or RT and LT when both sides are treated, but bill interlaminar codes once per session. Do not bill fluoroscopy separately, since imaging is included, and bill the injected drug with its HCPCS code and the JW or JZ modifier for Medicare.

Transforaminal codes are per side: use modifier 50 (or RT and LT) for bilateral injections at the same level
Interlaminar codes are billed once per session, not per side
Do not bill fluoroscopy (77003) separately with codes that include imaging
Bill the injected drug with its HCPCS code and the JW or JZ modifier for Medicare

Common denials

Why are epidural steroid injection claims denied?

These are the denial reasons we see most often. We check for each one before a claim goes out, instead of finding out from a denial.

Denials we prevent

No documentation of conservative care before the injection
Repeat injection without documented relief from the previous one
Frequency limit for the spinal region exceeded
Missing prior authorization, including under WISeR in New Jersey
Bilateral transforaminal injection billed without modifier 50 or RT/LT

FAQ

Epidural Steroid Injections questions

What is the CPT code for a lumbar epidural steroid injection?

A lumbar interlaminar or caudal ESI with imaging guidance is CPT 62323. A lumbar transforaminal ESI is 64483 for the first level and +64484 for each additional level.

Is fluoroscopy billed separately with an epidural injection?

No. Codes 62321, 62323 and 64479 to 64484 include imaging guidance, so fluoroscopy or CT guidance is not billed separately.

How is a bilateral transforaminal ESI billed?

Bill the transforaminal code once with modifier 50, or on two lines with RT and LT, depending on the payer's rules.

Sources

Coverage rules change; always check the current version of each policy and your payer’s own rules.

Keep reading

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Prior Authorization

Approvals for injections, RFA, SCS and kyphoplasty, matched to each payer's criteria.

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