Trigger Point Injections (TPI)

Trigger point injections are covered for focal myofascial pain when a clinical trigger point is documented on exam and either conservative therapy has failed, movement is limited, or TPI is required diagnostically; repeat injections require prior documented >=50% pain relief lasting >=6 weeks and objective functional improvement. Documentation must include validated pain and functional scales (same scale pre/post), dates/duration of relief, and active participation in conservative care; no more than three TPI sessions are reimbursed per rolling 12 months. Use of biologic injectates, imaging guidance with fluoroscopy/MRI (and investigational ultrasound guidance), routine continuous use for chronic non-malignant pain, multiple anatomical-region injections in one session, and concurrent other blocks are not covered.

"Initial TPI is covered for myofascial pain when there is a focal area of skeletal muscle pain and clinical evidence of a trigger point defined by at least two findings (e."