Epidural steroid injections are performed at outpatient pain clinics, ambulatory surgery centers, and hospital outpatient departments. The procedure takes 15 to 30 minutes, and you go home the same day. Most people get a referral from their primary care doctor or orthopedic surgeon, but pain management clinics are the most common destination for the actual injection.
Types of Facilities That Offer the Procedure
Three main settings perform epidural steroid injections. Pain management clinics are the most common. These are standalone or group practices staffed by specialists who focus exclusively on diagnosing and treating chronic pain. They typically have fluoroscopy (real-time X-ray) equipment on site, which is used to guide the needle during the injection.
Ambulatory surgery centers are another option. These are outpatient facilities designed for procedures that don’t require an overnight hospital stay. They often cost less than hospital-based settings because their overhead is lower. Hospital outpatient departments also perform the injections, usually within a radiology or pain management suite. If you have a complex medical history or need sedation, a hospital setting may be preferred.
Specialists Who Perform the Injection
Several types of doctors are trained to do epidural steroid injections. The most common are physiatrists (doctors specializing in physical medicine and rehabilitation), anesthesiologists with pain management fellowships, and interventional radiologists. Some orthopedic spine surgeons and neurologists with interventional training also perform them.
What matters most is that the provider regularly performs image-guided spinal injections. Fluoroscopy or CT guidance is standard for accurate needle placement. If a provider doesn’t use imaging guidance, that’s a reason to look elsewhere. You can verify a pain specialist’s board certification through the American Board of Pain Medicine’s online directory, which pulls directly from their certification database and only lists currently certified physicians.
How to Get a Referral
The typical path starts with your primary care doctor, orthopedist, or neurologist. Before referring you for an injection, they’ll usually want imaging first. An MRI is the preferred study because it shows soft tissue detail like disc herniations and nerve compression. A CT scan is the backup option if you can’t get an MRI (for example, if you have certain implants). The imaging helps the specialist confirm what’s causing your pain and plan exactly where to place the injection.
Insurance plans, including Medicare, generally require that you’ve tried conservative treatments for at least four weeks before they’ll approve an epidural steroid injection. Conservative treatment includes things like physical therapy, oral anti-inflammatory medications, and activity modification. The exception is acute shingles pain, which can skip the four-week waiting period. If your insurance requires prior authorization, your referring doctor’s office typically handles the paperwork.
What the Visit Looks Like
You may be told not to eat or drink for a set number of hours beforehand. If you take blood thinners, including aspirin, your doctor will give you specific instructions on whether to stop them and when. Make sure you’re clear on exactly what’s expected, because the guidance varies depending on the medication and your medical history.
The injection itself takes 15 to 30 minutes. You’ll lie face down on a procedure table while the specialist uses fluoroscopy to guide a thin needle into or near the epidural space around your spinal nerves. A contrast dye is injected first to confirm correct placement, then the steroid medication is delivered. Most people feel pressure rather than sharp pain, especially if a local anesthetic is used to numb the skin first.
Afterward, you’ll rest in a recovery area for anywhere from a few minutes to an hour so the staff can watch for any immediate reactions. You’ll need someone to drive you home. Most people return to normal activities within a day or two, though your doctor may recommend avoiding strenuous activity for 24 to 48 hours.
How Many Injections You Can Get
Medicare limits epidural steroid injections to four sessions per spinal region in a rolling 12-month period, and most private insurers follow similar guidelines. The Hospital for Special Surgery recommends three to six injections per year as a general ceiling. For a new disc herniation, injections may be spaced just weeks apart to resolve symptoms quickly. For chronic conditions, three to six months between injections is more typical.
Doctors are not supposed to prescribe a predetermined series of injections. Each one should be evaluated based on how you responded to the last. If you’re still getting injections after 12 months without meaningful improvement, your provider should reassess whether the approach is working, and insurers may flag continued treatment for review.
Cost and Insurance Coverage
Most private insurance plans and Medicare cover epidural steroid injections when medical necessity criteria are met. You’ll typically owe a copay or coinsurance based on your plan. The total cost varies significantly depending on the facility. Hospital outpatient departments tend to charge more than freestanding surgery centers or pain clinics.
Without insurance, expect to pay roughly $158 for the physician’s fee plus around $513 for the facility fee at a surgery center, totaling about $670 for a single-level injection. These are benchmark figures, and actual prices vary by region and provider. If you’re paying out of pocket, ask for a cash-pay rate upfront, as many facilities offer a discount compared to their billed charges. Ambulatory surgery centers are generally the most affordable option for self-pay patients.
How to Find a Provider Near You
Start with your insurance company’s provider directory, filtering for pain management or physical medicine and rehabilitation. This ensures anyone you see is already in-network. If you want to verify credentials independently, the American Board of Pain Medicine maintains a searchable directory at their website where you can confirm a doctor’s current certification status.
When evaluating a provider, ask whether they use fluoroscopic guidance for all spinal injections, how many they perform per month, and what their complication rate looks like. High-volume providers tend to have better outcomes and fewer complications. If you’re in a rural area without a nearby pain specialist, many patients travel to regional medical centers or ambulatory surgery centers in larger towns for the procedure, since it’s a same-day visit with no overnight stay required.