Trigger Point Injections (TPI)

Trigger point injections (TPI) are covered for focal myofascial trigger point pain when clinical exam documents trigger point findings and conservative therapy has failed, movement is limited, or diagnostic confirmation is required. Repeat TPI is covered only if the prior injection gave ≥50% pain relief (measured with the same validated scale) lasting ≥6 weeks and recurrent pain causes objective functional limitation with documented functional improvement; no more than three TPI sessions are reimbursed per rolling 12 months. Imaging guidance (fluoroscopy/MRI) and biologic injectates are not covered, ultrasound guidance is investigational, and providers must be appropriately credentialed with required documentation of pain and functional scales and participation in conservative therapy.

"There is a focal area of pain in skeletal muscle attributable to a trigger point."