Independence will introduce new medical policies to apply frequency limit periods for the use of trigger point injections in the treatment of myofascial pain syndrome. Myofascial trigger points are self-sustaining hyper-irritative foci that may occur in any skeletal muscle in response to strain produced by acute or chronic overload.
The following Independence policies were posted as Notifications on January 2, 2019, and will go into effect April 1, 2019:
- Commercial: #11.14.02n: Trigger Point Injections
- Medicare Advantage: #MA11.017e: Trigger Point Injections
Independence will apply frequency limit periods for the use of trigger point injections in the treatment of myofascial pain syndrome as follows:
- Commercial members: There will be a maximum of ten injection sessions in a 12-month calendar year.
- Medicare Advantage members: There will be a maximum of 12 injection sessions in a 12-month calendar year.
Note: Administration of injection services to a particular site, regardless of the number of injections, is considered one session.
For more information about the frequency limits on injection sessions, please refer to the Notifications for these policies on our Medical Policy Portal, select Accept and Go to Medical Policy Online, and then select Commercial or Medicare Advantage under Active Notifications.