Trigger Point Injections and Dry Needling

Trigger Point Injections and Dry Needling

5/10/2016

BlueCross® BlueShield® of South Carolina and BlueChoiceHealthPlan create and update medical policies to address frequently occurring clinical situations. We are implementing a new medical policy that addresses dry needling and trigger point injections which will be effective August 1, 2016.

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. Injection of an anesthetic agent into trigger points is also being evaluated for the management of myofascial pain.

Overall, dry needling of trigger points has not been shown to be clinically superior to sham treatment or manual therapy. In addition, dry needling is associated with a high incidence of mild adverse events. The evidence is insufficient to determine the effects of the technology on health outcomes.

The evidence for trigger point injections in individuals who have trigger points associated with myofascial pain includes several small RCTs. One small RCT found that lidocaine injections into trigger points may relieve myofascial pain to a greater extent than dry needling. However, only one other small study was sham-controlled and infiltration with lidocaine was not superior to a lidocaine patch in another. The evidence is insufficient to determine the effects of the technology on health outcomes.

There is currently no specific CPT code for dry needling, although the AMA CPT instructs that the unlisted code 20999 should be used for this procedure. Dry needling is not acupuncture, so CPT codes 97780-97781 are not appropriate for reporting dry needling.

Trigger point injections are reported with CPT codes 20552 and 20553.

Effective August 1, 2016, these procedures will be considered investigational. We will not cover services for either of these procedures for dates of service on or after August 1.

Please contact Provider Education for information about this bulletin at provider.education@bcbssc.com or by calling 803-264-4730.

BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.