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DESCRIPTIONTrigger points are small, definite (confined to a limited space) abnormally sensitive areas in muscles, ligaments, joint capsules, tendons and related tissues that have a specific and typical area of referred pain. The trigger point is so called because its stimulation reproduces the pain complained of. Any kind of local injury to myofascial structures can induce trigger points. Other causes of trigger points are inflammation (myositis bursitis, fibrositis, arthritis, tendonitis, etc.) connective tissue disease and chronic infection.
Anesthetization of trigger points (also called myofascial or paravertebral muscle injections) relieves spasms and diminishes pain associated with myofascial pain (fibromyalgia, fibromyositis, myofascitis). Injections should generally be used with physical therapy so that the patient can take advantage of the pain relief from the injections and increase activity tolerance.
POLICYTrigger point injection of abnormally sensitive areas in muscles, ligaments, joint capsules, tendons and related tissues may be considered medically necessary to relieve spasm and diminish myofascial pain.
One reimbursement will be made per site, per session, regardless of the number of trigger point injections.
Separate billing for the drug injected is not allowed. This is included in the administration of the injection.
Reimbursement for injections of tendon sheath, ligament, trigger points or ganglion cyst (CPT 20550) will be made up to a maximum of ten (10) sessions in a three (3) month period. Reimbursement for arthrocentesis, aspiration and/or injection of small and intermediate joints (CPT 20600 and 20605) will not exceed two (2) injections per joint within thirty (30) days. Reimbursement for arthrocentesis, aspiration and/or injection of major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa), CPT 20610, will not exceed four (4) services per site within a thirty (30) day period.
POLICY GUIDELINESBeyond the treatment limits specified, no coverage is allowed.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language
POLICY HISTORY8/1997: Approved by Medical Policy Advisory Committee (MPAC)
11/2000: Reviewed by MPAC, no changes
7/11/2001: Code Reference section updated; ICD-9 diagnosis codes 098.50, 726.0, 726.12, 726.5, 726.61, 726.71, 726.79, 726.90, 728.85 added; ICD-9 diagnosis codes 040.0, 074.1, 478.29, 727.2, 729.1 deleted
3/13/2002: New 2002 codes added
5/8/2002: Type of Service and Place of Service deleted
8/21/2003: CPT codes 20600, 20605 listed separately, CPT codes 20550, 20551, 20552, 20553 descriptions revised to be consistent with AMA, ICD-9 procedure codes 81.92, 83.97 descriptions revised to be consistent with AMA, arthritis, bursitis, fibrositis, myalgia and myositis, tendonitis ICD-9 diagnosis code ranges listed separately
11/5/2004: Code Reference section updated, CPT code 20612 added covered codes, ICD-9 procedure code 05.39, 76.96, 82.94, 82.95, 83.96, 83.98 added covered codes, ICD-9 diagnosis code 727.00, 727.01, 727.04, 727.05, 727.06, 727.09, 727.9, 729.1, 730.10, 730.11, 730.12, 730.13, 730.14, 730.15, 730.16, 730.17, 730.18, 730.19, 730.20, 730.21, 730.22, 730.23, 730.24, 730.25, 730.26, 730.27, 730.28, 730.29, 730.80, 730.81, 730.82, 730.83, 730.84, 730.85, 730.86, 730.87, 730.88, 730.89, 730.90, 730.91, 730.92, 730.93, 730.94, 730.95, 730.96, 730.97, 730.98, 730.99 added covered codes
7/20/2006: Policy reviewed, prior authorization language removed.
03/27/2014: Policy statement updated to add the following for clarity purposes: Trigger point injection of abnormally sensitive areas in muscles, ligaments, joint capsules, tendons and related tissues may be considered medically necessary to relieve spasm and diminish myofascial pain.
12/31/2014: Added the following new 2015 CPT codes to the Code Reference section: 20604, 20606, and 20611. Revised the description of the following CPT codes: 20600, 20605, and 20610. Effective 1/1/15.
Review of medical policy related to trigger point injections from Blue Cross & Blue Shield plans nationally.
Literature search through Grateful Med and MEDLINE databases focused on references containing the Medical Subject heading of arthrocentesis and trigger point.
Hayes Medical Technology Directory
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.
The code(s) listed below are ONLY medically necessary if the procedure is performed according to the "Policy" section of this document.