Cigna Epidural Steroid Injection (interlaminar / transforaminal) prior authorization requirements (2026)

Medical-necessity criteria Cigna generally applies

[NEEDS CLINICAL SPOT-CHECK] Governing document: "CIGNA MEDICAL COVERAGE POLICIES - MUSCULOSKELETAL, CMM-200: Epidural Steroid Injections", Comprehensive Musculoskeletal Management Guidelines V1.0.2026, effective 2026-08-04, published 2026-04-17. The document states verbatim: "This evidence-based medical coverage policy has been developed by EviCore, Inc." and "These guidelines apply to services or supplies managed by EviCore for Cigna as outlined by the Cigna CPT list." IMAGE GUIDANCE (verbatim): "When criteria have been met, epidural steroid injections and selective nerve root blocks are considered medically necessary when performed with CT- or fluoroscopic-guidance," with a criteria exception "for an emergent situation when fluoroscopic-guidance, CT-guidance, or the injection of contrast is contraindicated (e.g., pregnancy)." FREQUENCY (verbatim): "When criteria have been met, up to three (3) sessions of epidural steroid injections (ILESIs and/or TFESIs) per episode of pain, per region (cervical, thoracic, lumbar) during a six (6) month period and up to four (4) sessions during a rolling 12-month period are considered medically necessary." Also: "When criteria have been met, only one invasive modality or procedure performed on the same date of service is considered medically necessary," with an exception for a TFESI performed with a synovial cyst aspiration. LEVELS (verbatim): "a therapeutic transforaminal epidural steroid injection (TFESI) is considered medically necessary at no more than two (2) contiguous levels (whether unilateral or bilateral) during the same session"; "a diagnostic selective nerve root block (SNRB), is considered medically necessary at only one single level/single side during the same session"; "an interlaminar epidural steroid injection (ILESI) or caudal epidural steroid injection (Caudal ESI) is considered medically necessary at only one spinal level during the same session." INITIAL ESI — Treatment of Presumed Radiculitis or Radicular Pain (verbatim): "Failure of at least four (4) weeks of conservative treatment (e.g., exercise, physical therapy, chiropractic care, or medications to include nonsteroidal anti-inflammatory drugs [NSAIDs] or analgesics)"; "The individual is participating in an active rehabilitation program, home exercise program, or functional restoration program."; "Advanced imaging (e.g., MRI, CT, CT myelogram) within the past 24 months is required for cervical/thoracic interlaminar and transforaminal epidural steroid injections." INITIAL ESI — Treatment of Presumed Radiculopathy adds (verbatim) that symptoms must include "the presence of pain, dysesthesia(s), or paresthesia(s) in a level-specific referral pattern of an involved, named spinal root(s) causing significant functional limitations" plus ANY of: a detailed neurologic examination within the prior three (3) months showing loss of strength in a named muscle or myotomal distribution, altered sensation in the sensory distribution, or diminished/absent/asymmetric reflexes concordant with nerve root compression; OR "a concordant radiologist's interpretation of advanced imaging (e.g., MRI, CT, CT myelogram) within the past 24 months confirming compression of the involved, named spinal nerve root(s) or foraminal stenosis at the concordant level(s)"; OR "electrodiagnostic studies (EMG/NCV) within the past 24 months are diagnostic of nerve root compression of the involved named spinal nerve root(s)." INITIAL TRIAL FOR NEUROGENIC CLAUDICATION (verbatim) additionally requires that "Diagnostic evaluation has ruled out other potential causes of pain" and that "Advanced imaging (e.g., MRI, CT, CT myelogram) within the past 24 months confirms moderate to severe lumbar spinal stenosis at the level to be treated." REPEAT ESI (verbatim): medically necessary when ALL of "It has been at least 14 days since the prior epidural steroid injection (ESI)"; "There has been documented pain relief of at least 50% for at least two (2) weeks and EITHER of the following additional criteria has been met: increase in the level of function; reduction in the use of pain medication and/or additional medical services such as physical therapy/chiropractic care"; and "The individual is participating in an active rehabilitation program, home exercise program, or functional restoration program." DIAGNOSTIC SNRB (verbatim): an initial-level SNRB requires it be "Performed at a single nerve root", "Performed with anesthetic injectate", and performed "when attempting to establish the diagnosis of radicular pain (including radiculitis) or radiculopathy when the diagnosis remains uncertain after standard evaluation". An SNRB at a level other than the initial level requires that "The prior diagnostic SNRB resulted in less than 80% pain relief based on the injectate utilized", "Evidence of multilevel pathology", and "It has been at least seven (7) days since the prior diagnostic SNRB."

Commonly required documentation

• Documentation of at least 4 weeks of failed conservative treatment
• documentation that the individual is participating in an active rehabilitation, home exercise, or functional restoration program
• advanced imaging (MRI/CT/CT myelogram) within the past 24 months — mandatory for cervical/thoracic interlaminar and transforaminal injections
• a detailed neurologic examination within the prior 3 months, or concordant advanced-imaging interpretation, or EMG/NCV within the past 24 months, where radiculopathy is claimed
• documentation of CT or fluoroscopic guidance. For repeat injections: date of the prior ESI (>= 14 days), documented >= 50% pain relief lasting >= 2 weeks, plus increased function or reduced medication/services.

How to submit

• Method: Precertification through eviCore by Evernorth on behalf of Cigna. eviCore provider line 1.800.918.8924.
• Portal: eviCore by Evernorth (Cigna Musculoskeletal / Interventional Pain program)

Sources & verification

• BindingSource — Cigna Medical Coverage Policies - Musculoskeletal, CMM-200: Epidural Steroid Injections (V1.0.2026) (CMM-200) · effective 2026-08-04.View
• BindingSource — Cigna Provider Resources — solutions eviCore manages for Cigna (includes Musculoskeletal).View

Binding = the payer's own policy. Proxy = a public, evidence-based clinical guideline the payer mirrors. Portal-only = the binding criteria are confirmed in the administrator's portal. Always confirm against the payer for the member's specific plan. Last verified 2026-08-07.

Frequently asked questions

Other Cigna prior authorization requirements

Related guides