OBJECTIVES: To appraise existing economic evaluations of epidural steroid injections (ESIs) for lumbar spinal stenosis and to estimate Medicare-based reimbursed amounts. METHODS:   We searched PubMed through June 2011 for low back pain, spinal stenosis or sciatica, and ESI and included observational studies with cost outcomes. We performed a supplementary descriptive analysis of Medicare reimbursed amounts associated with ESI performed at a single institution in 2010.  RESULTS:    Our literature search indicated that rates of lumbar ESI increased 271% from 1994 to 2001 in Medicare beneficiaries ≥65 years of age with professional charges per injection nearly doubling ($115 to $227) during this time period. A second study found the rate of lumbar epidurals was 67% higher in 2006 versus 2002 in Medicare beneficiaries of any age, and allowed charges of all spine epidural increased from $336 to $395. Our single-institution estimation sample included 279 patients receiving one (n=179), two (N=93), three (N=30), or four (N=2) ESIs. We estimated mean total Medicare reimbursement per outpatient ESI episode procedure to be $635 in 2010 (technical reimbursement and estimated professional payment). The associated reimbursement estimates were $1239 and $1834 for those receiving 2 and 3 ESI episodes, respectively. CONCLUSIONS:   There are few studies investigating the economic impact of ESI procedures for lumbar spinal stenosis in the elderly, or providing estimates of technical and professional reimbursement amounts. Our single-institution estimate suggests that Medicare-based reimbursement is greater than $600 per ESI (technical and professional). More information on utilization, costs, and cost-effectiveness of ESI in treating lumbar spinal stenosis are needed.