Is a cervical interlaminar epidural steroid injection (CIESI) at C7-T1, procedure code 62321, medically indicated for a patient with cervical radiculopathy, who has failed to improve with conservative measures and experiences pain interfering with activities of daily living?

Medical Necessity Determination for Cervical Interlaminar Epidural Steroid Injection at C7-T1

Yes, this cervical interlaminar epidural steroid injection at C7-T1 is medically indicated for this patient with cervical radiculopathy who has failed conservative measures and experiences pain interfering with activities of daily living.

Primary Indication Criteria Met

• The American Society of Anesthesiologists strongly recommends epidural steroid injections specifically for patients with radicular pain or radiculopathy, which this patient has been diagnosed with 1
• The patient has documented failure of conservative measures, which is the prerequisite before considering epidural injection 1
• Pain interfering with activities of daily living represents significant functional impairment that justifies intervention 1

Anatomic Level Selection

• The C7-T1 interlaminar approach is appropriate and safe for cervical radiculopathy 1, 2
• A retrospective study of 12,168 cervical interlaminar epidural injections found no correlation between spinal level and complication rates, with C7-T1 being one of the most commonly used levels 2
• The interlaminar approach at C7-T1 is specifically recommended for bilateral symptoms or multilevel stenosis 1

Evidence for Efficacy

• Recent high-quality evidence demonstrates cervical epidural steroid injection leads to statistically significant improvement in pain interference scores at 3,6, and 12 months 1, 3
• A 2025 study using PROMIS outcomes showed pain interference improved by 2.2 points at 3 months, 2.3 points at 6 months, and 2.7 points at 12 months (all p<0.05) 3
• Treatment success rates for cervical epidural steroid injection are 93% at 1 month, 86% at 3 months, and 72% at 6 months 4
• The procedure is most effective when performed before irreversible nerve damage occurs 1

Mandatory Procedural Requirements

Fluoroscopic Guidance

• Fluoroscopic guidance must be used for cervical epidural injections to ensure proper needle placement and minimize risk of catastrophic complications 1, 2
• Cervical epidurography should be routinely performed prior to injection of therapeutic steroid and local anesthetic mixture 2

Patient Counseling

• The patient must be counseled about potential complications including dural puncture, insertion-site infections, sensorimotor deficits, spinal cord injury, and epidural hematoma 1
• Shared decision-making documentation must include discussion of risks specific to cervical injection 1
• While serious complications are rare (7 serious complications in 12,168 injections), the patient must understand these risks 2

Integration with Comprehensive Care

• CESI should be integrated with physical therapy once acute radicular pain is controlled 1
• The injection should be part of a multimodal treatment regimen, not a standalone intervention 1
• This approach reduces the rate of patients needing surgery 4

Common Pitfalls to Avoid

• Do not delay the procedure unnecessarily once conservative measures have failed, as this may lead to irreversible nerve damage 1
• Do not perform the injection without fluoroscopic guidance—this is mandatory for safety 1, 2
• Do not confuse this indication with non-radicular axial neck pain, which would not be appropriate for epidural steroid injection 5, 6
• Ensure documentation clearly establishes radicular symptoms (arm pain, sensory dysfunction, motor weakness) rather than isolated neck pain 1

Contrast with Surgical Alternatives

• While anterior cervical decompression surgery provides more rapid relief (within 3-4 months) compared to physical therapy, these gains equalize by 12 months 5
• Nonoperative management has success rates averaging 90% in acute cervical radiculopathy 5
• Epidural steroid injection serves as an appropriate intermediate step between failed conservative care and surgical decompression 1, 4

Documentation Requirements

• Confirm imaging demonstrates nerve root compression correlating with clinical symptoms 1
• Document specific radicular symptoms (dermatomal pain distribution, sensory changes, motor weakness) 1
• Record duration of conservative treatment failure 1
• Document functional limitations in activities of daily living 1