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Trigger point injection medical policy reminder
July 27, 2021

This article is for acute care hospitals, orthopedists, rheumatologists, and physical medicine and rehabilitation physicians who administer trigger point injections

Blue Cross covers trigger point injections for the treatment of myofascial pain syndrome as outlined in our existing medical policy, Trigger Point and Tender Point Injections, 604. As a reminder, there are several statements in the policy that describe conditions that must be met for the listed codes to be covered for our commercial members:

  • There is a regional pain complaint in the expected distribution of referral pain from a trigger point, AND
  • There is spot tenderness in a palpable taut band in a muscle, AND
  • There is restricted range of motion, AND
  • Conservative therapy (for example, physical therapy, active exercises, ultrasound, heating or cooling, massage, activity modification, or pharmacotherapy) for six weeks has failed or is not feasible, AND
  • Trigger point injections are provided as a component of a comprehensive therapy program, AND
  • No more than four injections are given in a 12-month period.

Medical policy application

  • Enforcement of this medical policy occurs through system edits and post-payment reviews.
  • We continually expand our ability to process claims in accordance with this policy before we reimburse you, which will reduce the number of claims we review post-payment.


The included codes and diagnoses are listed on the Trigger Point and Tender Point Injections medical policy, which will be updated on our website on September 1.