Why Anthem BCBS Denies Epidural Steroid Injection
Exceeds frequency limit (usually 3 per year per region)
Conservative therapy not documented
Prior injection did not provide documented relief
Know Anthem / Blue Cross Blue Shield's Criteria
Anthem uses their own Clinical UM Guidelines and AIM Specialty Health for imaging. Medical policy numbers are publicly searchable.
Key policies to know:
- AIM Specialty Health manages imaging prior auth
- Clinical UM Guidelines searchable at anthem.com/provider
- Known for strict imaging prior auth requirements
- Uses evidence-based medicine approach with published policies
Building Your Medical Necessity Argument
Document radicular symptoms correlating with imaging
Note percentage and duration of relief from prior injection
Show failure of oral medications and PT
Reference imaging confirming nerve compression at the targeted level
P2P Call Tips for Anthem BCBS
Reference specific Anthem Clinical UM Guideline by policy number
For imaging, address AIM criteria specifically
Anthem medical directors appreciate evidence-based arguments
Cite specific clinical criteria being met from their own policy
Guidelines to Reference
- ASIPP Guidelines for Interventional Pain Management
- NASS Coverage Recommendations for ESI
Relevant CPT Codes
Specialty: Pain Management / Anesthesiology
Want the full strategy?
The P2P Playbook covers payer-specific approaches for Epidural Steroid Injection denied by Anthem BCBS -- plus 15 denial objections with word-for-word responses, what reviewers are actually thinking, and the 60-second prep framework. Written by a medical director who reviewed cases for major payers.
Get The P2P Playbook -- $39Get a personalized P2P script in 60 seconds
Enter your specific case details and our AI generates a structured prep script tailored to Anthem BCBS's criteria.