People with bad backs and necks frequently need Epidural Steroid Injections (ESIs). These injections are usually performed by a pain specialist in an ASC (Ambulatory Surgery Center).  For decades the standard of care was for these procedures to be done with anesthesia sedation such as Monitored Anesthesia Care (MAC).  Medicare has now issued a new policy (L36920) in which they state that anesthesia is no longer needed because it is not medically reasonable and necessary. Why has Medicare changed the rule after all these years? Basically, this is a sad attempt to save money and shift the cost to the patient.  It is much safer to have a needle inserted into your spine if you are sedated and not fidgeting around on an operating table. Please help me change this Medicare policy.