Trigger Point Injections

Trigger point injections are covered for myofascial pain when objective clinical and physical exam evidence of a trigger point exists, conservative therapy has failed (or movement is limited or diagnostic confirmation is required), and patients are actively participating in a rehabilitative program. Repeat injections are only covered after a documented prior positive response (≥50% pain relief) that lasted ≥6 weeks and with documented functional recurrence showing ≥50% functional improvement from the prior TPI; no more than three TPI sessions are reimbursed per rolling 12 months. TPIs using biologics or non–local-anesthetic injectates, TPIs for listed investigational indications, imaging-guided TPIs (fluoroscopy/MRI not indicated; ultrasound investigational), routine periodic TPIs for chronic non-malignant pain, and concurrent multi-region or concurrent block procedures in the same session are not covered.

"TPI is covered for myofascial pain when there is a focal area of pain in skeletal muscle consistent with a trigger point."