Back Pain - Invasive Procedures

Aetna covers diagnostic facet joint injections (intra‑articular and medial branch blocks C2‑3 to L5‑S1) and trigger point injections for chronic neck/back pain only when strict criteria are met — facet injections require clinical signs of facet syndrome, provocative exam, imaging excluding other causes, ≥3 months of limiting pain after ≥6 weeks conservative therapy, and consideration of radiofrequency (RF) neurolysis (a second diagnostic injection at the same level is covered only if the first produced ≥80% relief for the expected anesthetic duration); trigger point injections (saline/corticosteroid/local anesthetic) are covered for myofascial pain >3 months with failed conservative care, identifiable trigger points, as part of a comprehensive pain program, with up to four sets per session and no repeats more often than every 7 days. Only one invasive modality is considered medically necessary at a time; facet injections are limited to ≤3 levels (≤6 bilateral injections) per session, additional repeat injections at the same levels are considered investigational/unproven, and diagnostic facet injections are not covered unless RF neurolysis is being considered.