Trigger Point Injections (TPI)

Trigger point injections are covered for myofascial pain when a focal skeletal muscle trigger point is clinically and physically identified and conservative therapy has failed or TPI is needed diagnostically. Repeat injections are covered only after documented prior benefit (≥50% pain relief on the same pain scale and ≥6 weeks of relief) and objective functional improvement (≥50%) documented with validated scales; no more than three TPI sessions are reimbursed per rolling 12 months, biologics and imaging guidance are largely excluded, and strict documentation and provider credentialing requirements apply.

"TPI is covered for myofascial pain caused by trigger points when there is a focal area of pain located in skeletal muscle."

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