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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101.The rules say that epidural injections are generally performed to treat pain arising from spinal nerve roots. EIs can be performed via an interlaminar or caudal approach or a transforaminal approach. An epidural injection is considered medically reasonable and necessary with the following conditions:1. Pain from Herpes Zoster or suspected radicular pain based on radiation of pain along the dermatome of a nerve.2. Pain from Neurogenic claudication that includes any of the following:-Pain severe enough to cause some degree of functional deficit;-Failure of at least four weeks of noninvasive care;-Imaging demonstrating a correlative region of nerve/cord impingement.3. Pain from Cervicothoracicor Lumbar radicular pain with any of the following:-Pain severe enough to cause some degree of functional deficit;-Failure of at least four weeks of non-invasive care;-Imaging demonstrating a correlative region of nerve impingement.4. Back pain without lower extremities symptoms and failure of four weeks of non-surgical, non-injection care with either:-documented VAS for pain or NPRS greater than or equal to 3/10 (moderate to severe pain), OR-functional impairment in ADLsAND-the pain or functional impairment is associated with any of the following:a. substantial imaging abnormality, such as a central disc herniation or high intensity zone;b. documented severe degenerative disc disease or central spinal stenosis;c. discogenic pain, not attributable to facet joint or sacroiliac joint pain.You can find this rule in Local Coverage Determination (LCD):Epidural Injections for Pain Management (L36920) -Effective July 1, 2020.The rules say that it is generally accepted that the majority of back radicular pain will improve with conservative treatment over a four week period. All appropriate non-surgical, non-injection treatments which includes appropriate oral medications and physical therapy (to the extent tolerated) should be considered along with a rationale for interventional treatment. Exceptions to the four week non-surgical/non-injection care prior to initiation of epidural injection therapy, should be documented. These may include, but are not limited to one or more of the following:-Pain from Herpes Zoster-Severe pain unresponsive to outpatient medical management-Inability to tolerate non-surgical, non-injection care due to co-existing medical conditions-At least moderate pain with significant functional loss at work or home-Prior successful lumbar injection for the same specific condition.You can find this rule in Local Coverage Determination (LCD):Epidural Injections for Pain Management (L36920) -Effective July 1,2020.The rules say that for purposes of this policy, a "session" is defined as all EIs, diagnostic selective nerve root blocks (DSNRBs) or spinal injection procedures performed on a single day. An injection is defined as the placement of a needle into the epidural space. Injecting one level bilaterally would be considered two injections. Injecting two levels, each unilaterally would be considered two injections. A maximum of two injections comprises a session, regardless of level, laterality or approach.A diagnostic selective nerve root block (DSNRB) is considered in the same manner as an Epidural Injection and constitutes one of the two injections allowed in a single session. No more than 3 epidural injection sessions (6 injections, including both diagnostic and therapeutic injections) may be performed in a 6-month period and no more than 6 epidural sessions (12 injections, including both diagnostic and therapeutic injections) may be performed in all anatomic regions in a 12-month period regardless of the number of levels involved. You can find this rule in Local Coverage Determination (LCD):Epidural Injections for Pain Management (L36920) -Effective July 1, 2020.If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.The Plan contract says that the Plan covers items and services in accordance with Medicare rules.