Trigger Point Injections (TPI)

Trigger point injections are covered for focal myofascial pain when a trigger point is clinically documented (specific palpatory findings and exam evidence), conservative therapy has failed (unless movement is limited or TPI is needed diagnostically), and documented objective pain and functional responses support benefit. Repeat injections are covered only if prior TPI provided at least 50% pain relief (measured on the same documented scale) with relief lasting ≥6 weeks and recurrence causes objective functional limitation with documented ≥50% improvement on functional scales. Coverage excludes biologic injectates, use of certain imaging guidance (fluoroscopy/MRI), ultrasound is investigational, multiple-region or concurrent block procedures in the same session, routine continuous TPIs for chronic non-malignant pain, and many specified conditions (e.g., fibromyalgia, CRPS); providers must document required assessments and appropriate credentialing.

"There is a focal area of pain located in skeletal muscle."