Trigger Point Injections for Pain Management

This policy covers trigger point injections (including local anesthetic/corticosteroid injections, dry needling, saline/glucose injections, and botulinum toxin when used during injections) for diagnosis, stabilization, and adjunctive treatment of myofascial trigger points causing chronic myofascial pain (typically >3 months) that are identified by palpation and limited to discrete areas (not widespread/fibromyalgia). Coverage requires documentation of ≥3 weeks of conventional multidisciplinary therapy (or documented contraindication/intolerance), physician administration, and is limited to a maximum of six total sessions—initially up to two sets for diagnosis/stabilization (≥7 days apart) with additional up to four only if prior injections produced ≥50% pain relief with functional improvement lasting ≥6 weeks and symptoms recurred after ≥6 weeks—with only one invasive pain procedure allowed per visit.

"Diagnosis or stabilization of myofascial trigger points using injections of corticosteroid and/or local anesthetic."