CMM-202: Trigger Point Injections

Trigger point injections are medically necessary only when a myofascial trigger point is identified by one or more exam findings (referred pain, tenderness, muscle shortening, or autonomic signs) and the injection uses a local anesthetic with or without steroid; repeat injections require ≥50% pain relief with functional improvement for ≥6 weeks and documented self‑management instruction. Not covered are injections using non‑local anesthetic substances (e.g., saline/glucose/biopuncture), dry needling, acupuncture/electro‑acupuncture, same‑day other regional treatments, image‑guided injections over spinal hardware, repeat injections as isolated therapy, intervals <2 months, or >4 sessions per body region/year, with documentation required for exam findings, agents used, pain relief/functional improvement, intervals, and session counts.

"Trigger point injections are considered medically necessary when BOTH of the following criteria are met: A myofascial trigger point has been identified by the presence of ONE or MORE of the followi..."