Trigger Point Injections

Trigger point injections are covered for patients with an established diagnosis of myofascial pain syndrome (MPS) documented by detailed history and physical exam, particularly after conservative therapies have failed, as bridging therapy, or when muscle dysfunction mechanically blocks joint movement (e.g., coccygeus muscle). Prolotherapy is explicitly not covered and billing it as a trigger point injection is prohibited; each injected site is billed as a single injection service regardless of needle count. Documentation must include diagnostic findings, prior conservative treatment or rationale for bridging therapy, and be available for post-payment review and Contractor audit; frequency limits are specified in the LCD's Utilization Guidelines.

"Trigger point injection is covered for established myofascial pain syndrome (MPS) after diagnosis is documented by a detailed history and thorough physical examination."