Health Evidence Review Commission's Value-based Benefits Subcommittee

ESI is essential to get immediate pain relief, and get patients into PT or other active therapy.
He was concerned that not covering ESI would increase opioid use.
Olson and Gibson responded that VbBS decisions need to focus on the population studies
rather than personal anecdote. Williams raised a concern that the larger population studies
have conflicting results and that VbBS should not pick and choose what evidence to
consider. Smits noted that most studies found poor evidence of effectiveness for the
general population. Livingston pointed out that the AHRQ report noted that there were few
patients included with acute or subacute symptoms in the studies reviewed, and therefore
the AHRQ report may not reflect the population response for patients with acute/subacute
pain.
Hodges noted that ESI could be covered as an exception, but that she could not recall a
request for an exception for ESI from a patient with acute, incapacitating back pain. Her
exceptions normally involve patients with chronic back pain.
Pollack requested that when the coverage guidance goes back through re-review, that HTAS
or EGBS attempt to identify what subpopulations could benefit from ESI. Staff replied that
this was part of the re-review process.
Note: As the placement of epidural steroid injections were prioritized on the list based on
the coverage guidance prior to the biennial review resulting in the “package” of changes to
related to the treatment of conditions of the back and spine that are currently delayed,
changes involving the placement of ESI will occur at the time of the next set of interim
modifications to the list. The changes to the diagnostic guideline on advanced imaging of
the back were a part of the “package” of back changes, and therefore will only go into effect
once the implementation of those changes is lifted.
Recommended Actions:
1) Remove CPT 64483 (Injection(s), anesthetic agent and/or steroid, transforaminal
epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level) and
64484 (each additional level) from line 407 CONDITIONS OF THE BACK AND SPINE
2) Modify GN37 as shown in Appendix A
3) Remove 64484 (Injection(s), anesthetic agent and/or steroid, transforaminal epidural,
with imaging guidance (fluoroscopy or CT); lumbar or sacral, additional levels) from line
159 HERPES ZOSTER; HERPES SIMPLEX AND WITH NEUROLOGICAL AND
OPHTHALMOLOGICAL COMPLICATIONS
4) Place 64483 and 64484 ((Injection(s), anesthetic agent and/or steroid, transforaminal
epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral) on the Services
Recommended for Non-Coverage table
5) Delete guideline note 105 EPIDURAL STEROID INJECTIONS FOR LOW BACK PAIN as
shown in Appendix C
Value-based Benefits Subcommittee Minutes, 1/14/2016 Page 10