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A.2.01.100
Trigger points are discrete, focal, hyperirritable spots within a taut band of skeletal muscle fibers that produce local and/or referred pain when stimulated. Dry needling refers to a procedure whereby a fine needle is inserted into the trigger point to induce a twitch response and relieve the pain.
Myofascial Trigger Points
Myofascial pain is defined by the presence of trigger points which are discrete, focal, hyperirritable spots within a taut band of skeletal muscle fibers that produce local and/or referred pain when stimulated. Trigger points are likely a result of injury to muscle fibers, but the pathophysiology is not fully defined. Trigger points can be visualized by magnetic resonance imaging and elastography. The reliability of manual identification of trigger points has not been established.
Dry Needling
Dry needling refers to a procedure in which a fine needle is inserted into the skin and muscle at a site of myofascial pain. The needle may be moved in an up-and-down motion, rotated, and/or left in place for as long as 30 minutes. The intent is to stimulate underlying myofascial trigger points, muscles, and connective tissues to manage myofascial pain. Dry needling may be performed with acupuncture needles or standard hypodermic needles, but is performed without the injection of medications (eg, anesthetics, corticosteroids). Dry needling is proposed to treat dysfunctions in skeletal muscle, fascia, and connective tissue; diminish persistent peripheral pain; and reduce impairments of body structure and function.
The physiologic basis for dry needling depends on the targeted tissue and treatment objectives. The most studied targets are trigger points.
Deep dry needling is believed to inactivate trigger points by eliciting contraction and subsequent relaxation of the taut band via a spinal cord reflex. This local twitch response is defined as a transient visible or palpable contraction or dimpling of the muscle, and has been associated with alleviation of spontaneous electrical activity; reduction of numerous nociceptive, inflammatory, and immune system-related chemicals; and relaxation of the taut band. Deep dry needling of trigger points is believed to reduce local and referred pain, improve range of motion, and decrease trigger point irritability.
Superficial dry needling is thought to activate mechanoreceptors and have an indirect effect on pain by inhibiting C-fiber pain impulses. The physiologic basis for dry needling treatment of excessive muscle tension, scar tissue, fascia, and connective tissues is not as well described in the literature.
Dry needling is considered a procedure and, as such, is not subject to regulation by the U.S. Food and Drug Administration.
Dry needling of trigger points for the treatment of myofascial pain is considered investigational.
None
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
03/17/2016: Approved by Medical Policy Advisory Committee.
06/01/2016: Policy number A.2.01.100 added.
03/07/2017: Policy reviewed; no changes.
08/15/2017: Policy title changed from "Dry Needling and Trigger Point Injections for Myofascial Pain" to "Dry Needling of Myofascial Trigger Points." Policy description updated to remove information on trigger point injections. Policy statement revised to state that dry needling of trigger points for the treatment of myofascial pain is considered investigational. It previously stated: Dry needling and trigger point injections for the treatment of myofascial pain are considered investigational.
05/01/2018: Policy description updated. Policy statement unchanged.
05/06/2019: Policy description updated to remove information regarding alternative nonpharmacologic treatments for trigger point pain. Policy statement unchanged.
01/29/2020: Code Reference section updated to add CPT codes 20560 and 20561.
05/15/2020: Policy title changed from "Dry Needling of Myofascial Trigger Points" to "Dry Needling of Trigger Points for Myofascial Pain." Policy statement unchanged.
06/11/2021: Policy description updated. Policy statement unchanged.
05/23/2022: Policy reviewed; no changes.
05/05/2023: Policy description updated regarding trigger points. Policy statement unchanged.
05/06/2024: Policy reviewed; no changes.
05/06/2025: Policy reviewed; no changes.
Blue Cross Blue Shield Association policy # 2.01.100
Code Number | Description |
CPT-4 | |
20560 | Needle insertion(s) without injection(s); 1 or 2 muscle(s) |
20561 | Needle insertion(s) without injection(s); 3 or more muscles |
20999 | Unlisted procedure, musculoskeletal system, general |
HCPCS | |
ICD-10 Procedure | |
ICD-10 Diagnosis |
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