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A set of trigger point injections means injections in several trigger points in one sitting.

It is not considered medically necessary to repeat injections more frequently than every 7 days.

Trigger point injections are considered experimental and investigational for all other indications because their effectiveness for indications other than the ones listed above has not been established.

A trigger point is defined as a specific point or area where, if stimulated by touch or pressure, a painful response will be induced.

Epidural injections of corticosteroid preparations, with or without added anesthetic agents, are considered experimental and investigational for all other indications (e.g., non-specific low back pain [LBP] and failed back syndrome) because their effectiveness for indications other than the ones listed above has not been established.

Up to 4 sets of injections are considered medically necessary to diagnose the origin of a patient's pain and achieve a therapeutic effect; additional sets of trigger point injections are not considered medically necessary if no clinical response is achieved.

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If the member experiences no symptom relief or functional improvement after 2 sacroiliac joint injections, additional sacroiliac joint injections are not considered medically necessary.

Once the diagnosis is established, it is rarely medically necessary to repeat sacroiliac injections more frequently than once every 2 months.

Repeat injections extending beyond 12 months may be reviewed for continued medical necessity.

Ultrasound guidance of sacroiliac joint injections is considered not medically necessary.

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Repeated injections extending beyond 12 months may be reviewed for continued medical necessity.

Sacroiliac joint injections are considered experimental and investigational for all other indications because their effectiveness for indications other than the ones listed above has not been established.

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