Epidural steroid injections (ESI) are commonly used to treat back pain, sciatica, and spinal stenosis in Medicare beneficiaries. Medicare covers these injections when medically necessary — but you still pay 20% coinsurance. Here is what to expect.
Data source: CMS 2026 Medicare Physician Fee Schedule (MPFS) and OPPS/ASC Final Rules.
Based on CMS 2026 MPFS & OPPS Final Rules
Physician Fee — Lumbar ESI (CPT 62323)
Interlaminar or transforaminal approach; varies by technique and locality
~$200–$350
ASC Facility Fee
CMS 2026 ASC Final Rule — most ESIs done in ASCs or pain clinics
~$500–$700
HOPD Facility Fee
CMS 2026 OPPS — higher cost than ASC
~$700–$900
Fluoroscopy Guidance (CPT 77003)
Image guidance for needle placement — often billed separately
~$80–$120
Your 20% Share (no Medigap)
After Part B deductible; ASC setting per injection
~$140–$210
With Medigap Plan G
Only the annual Part B deductible (for the year)
~$283
Medicare typically covers 3 epidural injections per year per spinal region when medically necessary. Each injection is a separate claim and subject to 20% coinsurance.
Medicare Part B covers epidural steroid injections when medically necessary for conditions like herniated disc, spinal stenosis, or radiculopathy.
Medicare typically covers up to 3 injections per spinal region per year — additional injections may require prior authorization or documentation of medical necessity.
Fluoroscopy (X-ray guidance) is usually required for accurate needle placement and is billed separately.
Most epidural injections are performed in ambulatory surgery centers (ASCs) or office-based procedure suites.
The injection itself takes 15–30 minutes; you may need a driver as sedation is sometimes used.
Costs vary significantly by location and provider
Medicare pays physicians based on Geographic Practice Cost Indices (GPCI) that differ by locality. Your actual out-of-pocket cost depends on your deductible status, supplemental insurance, and whether your providers accept Medicare assignment. Use our free calculator for a personalized estimate.
Enter your location, insurance type, and deductible status for a precise out-of-pocket breakdown — surgeon fee, facility fee, anesthesia, and post-op costs all included.
Open Free CalculatorFree · No sign-up · Based on 2026 CMS official data
Data sources: CMS 2026 Medicare Physician Fee Schedule (MPFS), 2026 Outpatient Prospective Payment System (OPPS) Final Rule, and 2026 Ambulatory Surgical Center (ASC) Payment System. Estimates are for educational purposes only and do not constitute medical or financial advice.