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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 an epidural injection is considered medically reasonable and necessary with the following conditions: 

Each patient must be thoroughly evaluated by a physician or non-physician practitioner whose license and state scope of practice allow evaluation and treatment outlined in this LCD. A central or systemic source of pain or neurologic deficit shall be determined prior to epidural injection. If a central or systemic process is present, but the pain or neurologic deficit is clearly unrelated, injection therapy or EI may still be indicated when at least one of the indications listed below is present:

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:
&#8722; Pain severe enough to cause some degree of functional deficit;
&#8722; Failure of at least four weeks of noninvasive care;
&#8722; Imaging demonstrating a correlative region of nerve/cord impingement.
3. Pain from CervicoThoracic or Lumbar radicular pain with any of the following:
&#8722; Pain severe enough to cause some degree of functional deficit;
&#8722; Failure of at least four weeks of non-invasive care;
&#8722; 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:
&#8722; documented VAS for pain or NPRS greater than or equal to 3/10 (moderate to severe pain), OR
&#8722; functional impairment in ADLs; 
AND 
- the pain or functional impairment is associated with any of the following:
&#8722; substantial imaging abnormality, such as a central disc herniation or high intensity zone;
&#8722; documented severe degenerative disc disease or central spinal stenosis;
&#8722; discogenic pain, not attributable to facet joint or sacroiliac joint pain.

Contraindications to Epidural Injection or Diagnostic Selective Nerve Root Block
1. Cancer
&#8722; Medicare considers it not appropriate, as there would be no expected benefit, to perform an EI for a beneficiary with cancer where the tumor is invading a nerve root.
&#8722; Epidural injection of local anesthetic or anti-inflammatory agents is not appropriate for the management of non-lateralizing, non-specific pain or discomfort not related to inflammation, compression, or injury to spinal nerve roots or their extensions. It is considered not appropriate to perform EIs in the following situations (this list is not all inclusive):
&#8722; For patients with lung cancer irritating the pleura.
&#8722; For patients with large abdominal or pancreatic tumors.
&#8722; For cancer patients with generalized lateral pain.
&#8722; For pain due to metastatic disease.
2. Infection
&#8722; New onset of neck or back pain with fever in the absence of advanced imaging studies (to rule out local infection).
&#8722; Risk factors for spinal infection including fever or history of intravenous drug use.
&#8722; History of recent or ongoing bacterial or fungal infection.
&#8722; Immunosuppression.
3. Cauda Equina Syndrome
&#8722; New onset of urinary retention, fecal incontinence or saddle anesthesia.
&#8722; Rapidly progressing (or other) neurologic deficits.
4. A medical condition that contraindicates the intervention, (e.g., epidural hematoma, subarachnoid hemorrhage, epidural mass, spinal cord ischemia, trauma).
5. A co-existing medical condition or therapy that precludes the safe performance of the procedure (e.g., uncontrolled coagulopathy or active anti-coagulation therapy, sepsis).
6. The potential presence of a Central Nervous System process resulting in the presenting symptoms, (e.g., transverse myelitis, central demyelination) suggested by numbness or weakness without paresthesia/dysesthesia or pain.

You can find this rule in the Local Coverage Determination for Epidural Injections for Pain Management, L36920 (eff 07/01/20).

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.