CG-SURG-17 Trigger Point Injections

This policy addresses trigger point injections with local anesthetic, with or without steroid. Anthem considers them medically necessary when both general and specific criteria are met, including: a regional pain complaint; a documented neurologic/orthopedic/musculoskeletal evaluation with pain characteristics and physical exam; failure or infeasibility of conservative therapy; implementation of physical therapy or other modalities as needed to restore function/ADLs; and specific findings such as pain in a distribution consistent with a trigger point and a palpable taut band. They are not medically necessary when contraindications are present, including systemic infection, bleeding tendencies (e.g., anticoagulation), or other unstable medical conditions.

"Trigger point injections with a local anesthetic, with or without steroid, are consideredmedically necessarywhenallof the following general and specific criteria are met:General CriteriaThere is a ..."