Medicare Improperly Paid Physicians for Epidural Steroid Injection Sessions

Published 05/10/2023

A recent audit by the Office of the Inspector General (OIG) to determine whether Medicare made improper payments from January 1, 2019, to December 31, 2020 (the audit period), for epidural steroid injection sessions in the Medicare Administrative Contractor (MAC) jurisdictions that had defined coverage limitations.

The objective was to determine whether Medicare paid physicians for epidural steroid injection sessions in accordance with Medicare requirements. This audit found that Medicare improperly paid physicians $3.6 million on behalf of beneficiaries who received more epidural steroid injection sessions than were permitted by the coverage limitations in applicable local coverage determinations (LCD).

Palmetto GBA will work to identify any overpayments and issue demand letters, as appropriate. To address inappropriate billing for and overuse of epidural steroid injections, Medicare Administrative Contractors (MACs) developed coverage limitations for epidural steroid injection sessions.  Providers are reminded that Palmetto GBA has published guidelines regarding the limitations of coverage for Epidural Steroid Injections for Pain Management under Local Coverage Determination (LCD) L38994 and associated article A58695.  The OIG article and full report can be viewed using the links below.

Article: Medicare Improperly Paid Physicians for Epidural Steroid Injection Sessions A-07-21-00618 03-10-2023 (hhs.gov)

Complete Report: Medicare Improperly Paid Physicians for Epidural Steroid Injection Sessions, A-07-21-00618 (hhs.gov)


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