Medicare Coverage For Pain Injections: Your Guide To Getting The Relief You Deserve

Pain changes everything—how you move, how you sleep, how you live. And if you’re on Medicare, getting help shouldn’t add to the pain.

But for many patients, it does. You’re told to try more ice, more Tylenol, more therapy. You’re handed referrals, asked to wait three months, then told you don’t have the right documentation. All while the pain keeps getting worse.

If you’ve been considering an injection—whether it’s a nerve block, a radiofrequency ablation, or a steroid shot into your spine—you’re not alone. These treatments are widely used by Medicare patients, and many are covered under Part B when medically necessary.

This guide breaks down how it works: what’s covered, what Medicare requires, how prior authorization works, and what to do if you’re denied. We’ll also show you how to get real help if the paperwork starts piling up.

What Pain Injections Medicare Covers

When chronic pain doesn’t go away with conservative care, your doctor might recommend an injection to help block or reduce the pain signals. Medicare Part B covers several types of these procedures, as long as you meet the criteria for medical necessity.

(Coverage criteria and frequency limits may vary slightly by region. You can check your local Medicare policy using the CMS Local Coverage Determinations Database.)

Here’s what’s typically included—and what to know about each one:

Epidural steroid injections

These are commonly used for back or neck pain caused by disc issues or spinal stenosis. Medicare covers up to 4 sessions every 12 months. Coverage applies whether the injection is done in the lumbar, cervical, or thoracic spine—as long as imaging supports the diagnosis and you’ve tried other options first.

Facet joint interventions

Facet joint pain stems from the small stabilizing joints in your spine. Since July 2024, Medicare expanded coverage to include medial branch blocks as therapeutic, not just diagnostic. Most MACs allow 4–5 sessions per year, though limits can vary by region. Radiofrequency ablation (RFA) is often used after successful facet injections.

Trigger point injections

These injections treat painful “knots” in muscle—often caused by myofascial pain syndrome. Medicare covers them when other treatments haven’t worked and when your provider documents specific trigger points. All injections at a single site count as one service for billing purposes.

Nerve blocks

This category includes peripheral nerve blocks, genicular (knee) blocks, spinal nerve blocks, and sympathetic blocks. They're often used for complex regional pain syndrome, neuropathy, or severe joint pain that hasn’t responded to other care. These procedures require clear documentation of failed prior treatment and imaging support.

Joint injections (shoulder, knee, hip)

Injections into major joints are covered after 3+ months of conservative therapy—and with imaging proof of degenerative changes. For example, knee gel injections (viscosupplementation) require X-rays showing osteoarthritis plus failed physical therapy and NSAID use.

Radiofrequency ablation (RFA)

RFA targets pain nerves with heat to block signals longer-term. Medicare requires that you’ve had at least two successful diagnostic blocks before this procedure is approved. It’s often used after facet or medial branch block injections.

Understanding Your Costs

Medicare Part B will cover 80% of the approved amount for most pain injections once you’ve met your $257 annual deductible (2025). You’ll be responsible for the remaining 20% coinsurance—plus any uncovered facility fees.

Here’s what that could look like:

Example: If Medicare approves $1,000 for your procedure, you’ll typically pay $200 after meeting your deductible—unless you have a Medigap or Advantage plan that covers part of your share.

Below are some examples of what your 20% coinsurance might look like after you’ve met your deductible:

These amounts can vary depending on where your injection is done:

• Hospital outpatient departments may charge additional facility fees, increasing your out-of-pocket cost.
• Physician offices or ambulatory surgery centers often cost less overall.

If you have a Medigap plan:

Your 20% coinsurance may be partially or fully covered—depending on your plan.

If you're on a Medicare Advantage plan:

Expect plan-specific rules, such as:

• Different prior authorization policies
• Lower annual limits on injection sessions
• Varying cost-sharing structures

Always check with your plan before scheduling any procedure.

Navigating Prior Authorization

Since July 2023, Medicare has required prior authorization for some pain procedures—especially facet joint injections done in hospital outpatient settings.

This process can be frustrating, especially when you’re already in pain. But knowing how it works (and what to expect) can help you stay ahead of the delays.

What happens:

• Your doctor’s office submits your request—including your full documentation—to your Medicare Administrative Contractor (MAC).
• Review time is 7 calendar days for standard cases.
• Expedited requests (for urgent need) are reviewed in 2 business days.

Possible outcomes:

• Provisional affirmation – Medicare is likely to cover the treatment
• Non-affirmation – Medicare says the request doesn’t meet coverage rules
• Partial affirmation – Some parts of the treatment are approved, others denied

If your request is denied, it’s not the end of the road. You can appeal—and many people win on appeal with stronger documentation.

Getting Covered Step by Step

This process can feel like a maze. Here’s a clear path forward if you’re considering pain injections under Medicare:

1. Talk to your primary care doctor.

They’ll need to document your pain history, treatments you’ve tried, and how your daily life is affected.

2. Ask for a referral to a pain specialist.

Medicare typically requires that injections be ordered and performed by a qualified specialist.

3. Gather your records.

Make sure you have:

• Treatment history (including failed conservative options)
• Imaging (within 6 months)
• Notes on how pain limits your activities

4. Complete diagnostic steps.

Your specialist might order test injections (e.g., medial branch blocks) to prove the source of pain before doing a longer-term procedure like RFA.

5. Ask about prior authorization.

If it’s required, your doctor’s office will handle submission—but it helps to stay in touch about progress and timelines.

6. Follow up until you're approved.

Once Medicare gives the green light, you can schedule your injection.

This process takes coordination—and can stretch across weeks. The more proactive you are about gathering documentation, the faster things usually move.

Overcoming Common Challenges

Even when you do everything right, Medicare denials happen. And when they do, the most common reasons usually come down to:

• Missing or incomplete documentation – especially around conservative treatments or functional limitations
• Lack of imaging tied to your symptoms
• Too few details in the physician notes (e.g., “PT didn’t help” is less effective than “8 weeks of PT yielded <25% pain improvement”)

What to do if you’re denied:

• Don’t panic—and don’t assume the denial is final.
• 82% of Medicare appeals are partially or fully successful when patients have proper documentation.
• Ask your doctor to review the denial with you and help strengthen the case.

Medicare Advantage tip:

Plans often use automated systems or strict algorithms to deny injections—especially after a certain number per year. That doesn’t mean your case doesn’t qualify. It just means you’ll likely need to push back with specifics.

Your Appeal Rights

If Medicare denies your injection, that’s not the end of the story. You have the right to appeal—and if you’re willing to follow through, your odds are better than you might think.

In fact, 82% of Medicare appeals are successful, either fully or partially. But only a small number of patients ever file.

The first step: Redetermination

• Deadline: File within 120 days of the denial.
• What to include:
  • A support letter from your doctor explaining medical necessity
  • Any missing documentation—especially failed treatments, imaging, or pain scores
  • Any updates since the original request (worsening symptoms, reduced function)
• What happens next: The same Medicare Administrative Contractor (MAC) that denied you initially will review your case again. You'll get a decision within 60 days.

If that doesn't work: Level 2 Reconsideration

• Deadline: File within 180 days of getting your redetermination decision.
• Who reviews it: A Qualified Independent Contractor (QIC)—a completely different organization that wasn't involved in the original denial.
• Timeline: You'll get a decision within 60 days.

Level 3: Administrative Law Judge Hearing

• Requirements: Your case must be worth at least $190 (for 2025).
• Deadline: File within 60 days of the QIC's decision.
• Format: Most hearings are held by phone or video conference. You can present your case directly to the judge.

Beyond that: Two more levels

If needed, you can appeal to the Medicare Appeals Council (Level 4) and eventually to federal court (Level 5), though the federal court requires at least $1,840 in controversy.

How Solace Can Help

Solace advocates have helped hundreds of patients get pain injections covered—even after an initial denial. Our advocates work directly with your doctors to gather the right paperwork, explain the rules, and file appeals when things get rejected.

That’s exactly what we did for Joan, a Solace patient who'd spent years living with chronic pain. Joan had heard “no” more than once from Medicare—on pain injections, nerve blocks, and nearly everything else. Her Solace advocate helped her get a real diagnosis, connect with the right specialist, and finally start a treatment plan that worked. For the first time in years, she felt heard.

In the end, Joan’s advocate spotted what every other doctor had missed and helped her get pain injections approved as part of a new treatment plan.

Here’s what Solace brings to the table:

• We fill the gaps that get claims denied: From missing imaging to vague doctor notes, we help organize and flag the documentation that Medicare needs to see.
• We make the second request stronger than the first: If injections were denied, we help you appeal with better documentation and clearer rationale.
• We stay with you through the whole process: That includes joining specialist visits by phone or video, coordinating with your doctors, and tackling the paperwork.

You don’t have to figure this out alone. And you don’t have to accept a denial as the final word.

FAQ: Frequently Asked Questions About Medicare Coverage For Pain Injections and Nerve Blocks

How long do I have to try conservative treatments before Medicare approves injections?

Medicare generally requires documentation that you’ve tried conservative treatment—often for at least 3 months—before approving injections for chronic pain. For acute pain with severe functional limitations, this requirement may be shortened. Your doctor must clearly document what treatments you've tried and why they didn't provide adequate relief.

Will Medicare cover injections if I've already had surgery?

Yes, Medicare covers pain injections for post-surgical pain syndromes when medically necessary. You'll still need to meet documentation requirements and show that the injections are addressing ongoing pain not resolved by surgery.

How many injections can I get per year?

Coverage limits vary by injection type. Epidural steroid injections are limited to 4 sessions per 12 months. Most Medicare Administrative Contractors allow 4–5 facet joint injection sessions per year per spinal region, though limits may vary. Your specific Medicare Administrative Contractor sets exact limits, so check with your provider.

What's the difference between Medicare and Medicare Advantage coverage?

Original Medicare (Parts A and B) follows national coverage guidelines, while Medicare Advantage plans can impose additional restrictions like lower injection limits or different prior authorization requirements. Always verify coverage with your specific plan.

Can I get injections from any doctor?

Your provider must be enrolled in Medicare and meet specific qualification requirements. Most pain injections must be performed by specialists with appropriate training and in facilities with proper imaging equipment. Ask if your provider accepts Medicare assignment to avoid excess charges.

This article is for informational purposes only and should not be substituted for professional advice. Information is subject to change. Consult your healthcare provider or a qualified professional for guidance on medical issues, financial concerns, or healthcare benefits.

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