Subject:
Trigger Point Injections
Description:
_______________________________________________________________________________________
IMPORTANT NOTE:
The purpose of this policy is to provide general information applicable to the administration of health benefits that Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare of New Jersey, Inc. (collectively “Horizon BCBSNJ”) insures or administers. If the member’s contract benefits differ from the medical policy, the contract prevails. Although a service, supply or procedure may be medically necessary, it may be subject to limitations and/or exclusions under a member’s benefit plan. If a service, supply or procedure is not covered and the member proceeds to obtain the service, supply or procedure, the member may be responsible for the cost. Decisions regarding treatment and treatment plans are the responsibility of the physician. This policy is not intended to direct the course of clinical care a physician provides to a member, and it does not replace a physician’s independent professional clinical judgment or duty to exercise special knowledge and skill in the treatment of Horizon BCBSNJ members. Horizon BCBSNJ is not responsible for, does not provide, and does not hold itself out as a provider of medical care. The physician remains responsible for the quality and type of health care services provided to a Horizon BCBSNJ member.
Horizon BCBSNJ medical policies do not constitute medical advice, authorization, certification, approval, explanation of benefits, offer of coverage, contract or guarantee of payment.
__________________________________________________________________________________________________________________________
CMM-202: Trigger Point Injections
| CMM-202.1: Definitions |
| CMM-202.2: General Guidelines |
| CMM-202.3: Indications |
| CMM-202.4: Non-Indications |
| CMM-202.4: Procedure (CPT®) Codes |
CMM-202.1 Definitions
† Trigger point injections are defined as an injection of a local anesthetic with or without the addition of a corticosteroid into clinically identified myofascial trigger points.
† Myofascial trigger point is defined as a discrete, focal, hyperirritable spot found within a taught band of skeletal muscle or its fascia which when provocatively compressed causes local pain or tenderness as well as characteristic referred pain, tenderness and/or autonomic phenomena. Digital palpation, as well as needle insertion into the trigger point, can often lead to a local twitch response. A local twitch response is a transient visible or palpable contraction of the muscle. The presence of characteristic referred pain, tenderness, muscle shortening and/or autonomic phenomena (e.g., vasomotor changes, pilomotor changes, muscle twitches, etc.) is necessary to render the diagnosis of a myofascial trigger point. Tender points within a muscle or its fascia, which do not refer pain, tenderness and/or autonomic phenomena and lack a local twitch response, cannot be considered a myofascial trigger point.
Policy:
(NOTE: For Medicare Advantage, Medicaid and FIDE-SNP, please refer to the Coverage Sections below for coverage guidance.)
CMM-202.2 General Guidelines
† Trigger point injections are not without risk, and can expose members to potential complications.
† The determination of medical necessity for the use of trigger point injections is always made on a case-by-case basis.
CMM-202.3 Indications
† Trigger point injections are considered medically necessary when BOTH of the following criteria are met:
® A myofascial trigger point has been identified by the presence of ONE or MORE of the following on physical examination:
¡ Characteristic referred pain
¡ Tenderness
¡ Muscle shortening
¡ Autonomic phenomena (e.g., vasomotor changes, pilomotor changes, muscle twitches, etc.)
® Performed using a local anesthetic with or without steroid (e.g., saline or glucose)
† Repeat trigger point injections are considered medically necessary when BOTH of the following are documented:
® At least 50% pain relief with evidence of functional improvement for a minimum of six (6) weeks following the prior injection(s)
® Adequate instruction or supervision in self-management strategies (i.e., therapeutic exercise, ergonomic advice, ADL training, etc.)
CMM-202.4: Non-indications
† Trigger point injections are considered not medically necessary for any of the following:
® When performed with any substance other than local anesthetic with or without steroid (e.g., saline or glucose)
® When performed on the same day of service as other treatments in the same region
® When requested for any of the following:
¡ Acupuncture
¡ Electro-Acupuncture
¡ Acupoint injections, aka Biopuncture (saline, sugar, herbals, homeopathic substances)
¡ Dry needling
¡ Image-guided injection over spinal hardware
† Repeat trigger point injections are considered not medically necessary for any of the following:
® An isolated treatment modality
® An interval of less than two (2) months
® More than four (4) trigger point injection sessions per body region per year
CMM-202.4 Procedure (CPT®) Codes
| This guideline relates to the CPT® code set below. Codes are displayed for informational purposes only. Any given code’s inclusion on this list does not necessarily indicate prior authorization is required. Pre- authorization requirements vary by individual payor. |
| CPT® | Code Description/Definition |
| 20552 | Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) |
| 20553 | Injection(s); single or multiple trigger point(s), 3 or more muscle(s) |
| This list may not be all inclusive and is not intended to be used for coding/billing purposes. The final determination of reimbursement for services is the decision of the individual payor (health insurance company, etc.) and is based on the member/patient/client/beneficiary’s policy or benefit entitlement structure as well as any third party payor guidelines and/or claims processing rules. Providers are strongly urged to contact each payor for individual requirements if they have not already done so. |
Medicare Coverage:
There is no National Coverage Determination (NCD) for Trigger Point Injections. In the absence of an NCD, coverage decisions are left to the discretion of Local Medicare Carriers. Novitas Solutions, Inc, the Local Medicare Carrier for jurisdiction JL, has determined that Trigger Point Injections are covered when individuals meet LCD L35010 and Article A57751 criteria. For additional information and eligibility, refer to Local Coverage Determination (LCD): Trigger Point Injections (L35010) and Local Coverage Article: Billing and Coding: Trigger Point Injections (A57751). Available to be accessed at Novitas Solutions, Inc., Medical Policy Search page: https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00024370.
Required Documentation
For the treatment of established trigger points, the individual’s medical record must have:
· Documentation of the evaluation/ process of arriving at the diagnosis of the trigger point in an individual muscle must be clearly documented in the individual’s medical record
· The reason for the trigger point injection, and whether it is being used as an initial or subsequent treatment for myofascial pain, as well as the appropriate diagnosis code must be documented in the individual’s medical record.
Local Coverage Article: Billing and Coding: Trigger Point Injections (A57751). Available to be accessed at Novitas Solutions, Inc., Medical Policy Search page: https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00024370.
Medicaid Coverage:
For members enrolled in Medicaid and NJ FamilyCare plans, Horizon BCBSNJ applies the above medical policy.
FIDE SNP:
For members enrolled in a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP): (1) to the extent the service is covered under the Medicare portion of the member’s benefit package, the above Medicare Coverage statement applies; and (2) to the extent the service is not covered under the Medicare portion of the member’s benefit package, the above Medicaid Coverage statement applies.
________________________________________________________________________________________
Horizon BCBSNJ Medical Policy Development Process:
This Horizon BCBSNJ Medical Policy (the “Medical Policy”) has been developed by Horizon BCBSNJ’s Medical Policy Committee (the “Committee”) consistent with generally accepted standards of medical practice, and reflects Horizon BCBSNJ’s view of the subject health care services, supplies or procedures, and in what circumstances they are deemed to be medically necessary or experimental/ investigational in nature. This Medical Policy also considers whether and to what degree the subject health care services, supplies or procedures are clinically appropriate, in terms of type, frequency, extent, site and duration and if they are considered effective for the illnesses, injuries or diseases discussed. Where relevant, this Medical Policy considers whether the subject health care services, supplies or procedures are being requested primarily for the convenience of the covered person or the health care provider. It may also consider whether the services, supplies or procedures are more costly than an alternative service or sequence of services, supplies or procedures that are at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the relevant illness, injury or disease. In reaching its conclusion regarding what it considers to be the generally accepted standards of medical practice, the Committee reviews and considers the following: all credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, physician and health care provider specialty society recommendations, the views of physicians and health care providers practicing in relevant clinical areas (including, but not limited to, the prevailing opinion within the appropriate specialty) and any other relevant factor as determined by applicable State and Federal laws and regulations.
___________________________________________________________________________________________________________________________
Index:
Trigger Point Injections
References:
1. Al-Shenqiti A. Oldham J. Test-retest reliability of myofascial trigger point detection in patients with rotator cuff tendonitis. Clinical Rehabilitation. 19(5):482-7, 2005 Aug.
2. Alvarez D, Rockwell P. Trigger points: diagnosis and management. American Family Physician. 65(4):653-60, 2002 Feb 15.
3. American College of Occupational and Environmental Medicine. Occupational Medicine Practice Guideline, 2nd Ed. 2008. Accessed 10/1/08.
4. Audette J, Wang F, Smith H. Bilateral activation of motor unit potentials with unilateral needle stimulation of active myofascial trigger points. American Journal of Physical Medicine & Rehabilitation. 83(5):368-74, quiz 375-7, 389, 2004 May.
5. Bajaj P, Bajaj P, Graven-Nielsen T, et al: Trigger points in patients with lower limb osteoarthritis. J Musculoskeletal Pain 2001;9:17–33.
6. Baldry P. Management of myofascial trigger point pain. Acupunct Med 2002;20:2–10 25. Chu J: Does EMG (dry needling) reduce myofascial pain symptoms due to cervical nerve root irritation? Electromyogr Clin Neurophysiol 1997;37:259–72.
7. Bron C, Wensing M, Franssen JL, Oostendorp R. Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial. BMC Musculoskeletal Disorders. 8:107, 2007.
8. Carlsson C. Acupuncture mechanisms for clinically relevant long-term effects—reconsideration and a hypothesis. Acupunct Med 2002;20:82–99.
9. Casimiro L, Brosseau L, Milne S, et al: Acupuncture and electroacupuncture for the treatment of
10. RA. Cochrane Database Syst Rev 2002;(3):CD003788.
11. Chen J, Chung K, Hou C, et al: Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle. Am J Phys Med Rehabil 2001;80:729–35.
12. Chen Q, Bensamoun S, Basford J, et al . Identification and quantification of myofascial taut bands with magnetic resonance elastography. Arch Phys Med Rehabil 2007;88(12): 1658–61.
13. Chen S, Chen J, Wu Y, et al: Myofascial trigger point in intercostal muscles secondary to herpes zoster infection to the intercostal nerve. Arch Phys Med Rehabil 1998;79:336–8.
14. Chu J. Twitch-obtaining intramuscular stimulation: observation in the management of radiculopathic chronic low back pain. J Musculoskeletal Pain 1999;7:131–46.
15. Cole T, Edgerton V. Musculoskeletal disorders. In: Cole T, Edgerton V, eds. Report of the Task Force on Medical Rehabilitation Research: June 28-29, 1990, Hunt Valley Inn, Hunt Valley, Md. Bethesda: National Institutes of Health, 1990:61-70.
16. Couppe C, Torelli P, Fuglsang-Frederiksen A, et al. Myofascial trigger points are very prevalent in patients with chronic tension-type headache: a double-blinded controlled study. Clinical Journal of Pain. 23(1):23-7, 2007 Jan.
17. Cummings T, White A: Needling therapies in the management of myofascial trigger point pain: a systemic review. Arch Phys Med Rehabil 2001;82:986–92.
18. Davies C, Davies A. The Trigger Point Therapy Workbook (2nd Ed.). USA: New Harbinger Publication, Inc., 2004;323.
19. Ettlin T, Schuster C, Stoffel R, et al. A distinct pattern of myofascial findings in patients after whiplash injury. Archives of Physical Medicine & Rehabilitation. 89(7):1290-3, 2008 Jul.
20. Fernandez-Carnero J, Fernandez-de-Las-Penas C, de la Llave-Rincon AI, et al. Prevalence of and referred pain from myofascial trigger points in the forearm muscles in patients with lateral epicondylalgia. Clinical Journal of Pain. 23(4):353-60, 2007 May.
21. Fernandez-de-Las-Penas C. Alonso-Blanco C. Cuadrado ML. Et al. Myofascial trigger points and their relationship to headache clinical parameters in chronic tension-type headache. Headache. 46(8):1264-72, 2006 Sep.
22. Fernandez-de-Las-Penas C, Cuadrado M, Arendt-Nielsen L, et al. Association of cross-sectional area of the rectus capitis posterior minor muscle with active trigger points in chronic tension-type headache: a pilot study. American Journal of Physical Medicine & Rehabilitation. 87(3):197-203, 2008 Mar.
23. Fernandez de las Penas C, Cuadrado M, Gerwin R, Pareja J. Referred pain from the trochlear region in tension-type headache: a myofascial trigger point from the superior oblique muscle. Headache. 45(6):731-7, 2005 Jun.
24. Fernandez-de-Las-Penas C, Cuadrado M, Pareja JA. Myofascial trigger points, neck mobility, and forward head posture in episodic tension-type headache. Headache. 47(5):662-72, 2007 May.Fernandez-de-Las-Penas C, Ge H, Arendt-Nielsen L, et al. Referred pain from trapezius muscle trigger points shares similar characteristics with chronic tension type headache. European Journal of Pain: Ejp. 11(4):475-82, 2007 May.
25. Fernandez-de-Las-Penas C, Simons D, Cuadrado M, Pareja J. The role of myofascial trigger points in musculoskeletal pain syndromes of the head and neck. Current Pain & Headache Reports. 11(5):365-72, 2007 Oct.
26. Ferrante F, Bearn L, Rothrock R, King L. Evidence against trigger point injection technique for the treatment of cervicothoracic myofascial pain with botulinum toxin type A. Anesthesiology. 103(2):377-83, 2005 Aug.
27. Fischer A. Injection techniques in the management of local pain. J Back Musculoskeletal Rehabil 1996;7:107-17.
28. Fischer A. New approaches in treatment of myofascial pain. Phys Med Rehabil Clin North Am 1997;8:153-69.
29. Fischer A. Pressure threshold measurement for diagnosis of myofascial pain and evaluation of treatment results. Clin J Pain 1987;2:207–14.
30. Fischer A. Pressure threshold meter: its use for quantification of tender spots. Arch Phys Med Rehabil 1986;67:836–8.
31. Fricton J, Kroening R, Haley D, Siegert R. Myofascial pain syndrome of the head and neck: a review of clinical characteristics of 164 patients. Oral Surg Oral Med Oral Pathol 1985;60:615-23.
32. Ga H, Choi J, Park C, Yoon H. Acupuncture needling versus lidocaine injection of trigger points in myofascial pain syndrome in elderly patients--a randomised trial. Acupuncture in Medicine. 25(4):130-6, 2007 Dec.
33. Ga H, Choi J, Park C, Yoon H. Dry needling of trigger points with and without paraspinal needling in myofascial pain syndromes in elderly patients. Journal of Alternative & Complementary Medicine. 13(6):617-24, 2007 Jul-Aug.
34. Ga H, Koh H, Choi J, Kim C. Intramuscular and nerve root stimulation vs. lidocaine injection to trigger points in myofascial pain syndrome. Journal of Rehabilitation Medicine. 39(5):374-8, 2007 May.
35. Gam A, Warming S, Larsen L, Jet al, Treatment of myofascial trigger-points with ultrasound combined with massage and exercise--a randomised controlled trial. Pain. 77(1):73-9, 1998 Jul.
36. Ge H, Zhang Y, Boudreau S, et al. Induction of muscle cramps by nociceptive stimulation of latent myofascial trigger points. Experimental Brain Research. 187(4):623-9, 2008 Jun.
37. Gerwin R, Shannon S, Hong C, et al. Interrater reliability in myofascial trigger point examination. Pain. 1997 Jan;69(1-2):65-73.
38. Giamberardino M, Tafuri E, Savini A, et al. Contribution of myofascial trigger points to migraine symptoms. Journal of Pain. 8(11):869-78, 2007 Nov.
39. Gunn C. Treatment of Chronic Pain. Intramuscular Stimulation for Myofascial Pain of Radiculopathic Origin. London, Churchill Livingston, 1996.
40. Han S, Harrison P. Myofascial pain syndrome and trigger-point management. Reg Anesth 1997;22: 89-101.
41. Hanten W, Olson S, Butts N, Nowicki A. Effectiveness of a home program of ischemic pressure followed by sustained stretch for treatment of myofascial trigger points. Physical Therapy. 80(10):997-1003, 2000 Oct.Ho K, Tan K. Botulinum toxin A for myofascial trigger point injection: a qualitative systematic review. European Journal of Pain: Ejp. 11(5):519-27, 2007 Jul.
42. Hoheisel U, Mense S, Simons D, et al: Appearance of new receptive fields in rat dorsal horn neurons following noxious stimulation of skeletal muscle: a model for referral of muscle pain? Neurosci Lett 1993;153:9–12.
43. Hong C. Algometry in evaluation of trigger points and referred pain. J Musculoskeletal Pain 1998;6:47–59.
44. Hong C, Chen J, Chen S, et al: Histological findings of responsive loci in a myofascial trigger spot of rabbit skeletal muscle from where localized twitch responses could be elicited. Arch Phys Med Rehabil 1996;77:962.
45. Hong C, Chen Y, Twehous D, et al: Pressure threshold for referred pain by compression on the trigger point and adjacent areas. J Musculoskeletal Pain 1996;4:61–79.
46. Hong C. Consideration and recommendation of myofascial trigger point injection. J Musculoskeletal Pain 1994;2:29–59.
47. Hong C. Current research on myofascial trigger points—pathophysiological studies. J Musculoskeletal Pain 1999;7:121–9.
48. Hong C, Hsueh T. Difference in pain relief after trigger point injections in myofascial pain patients with and without fibromyalgia. Arch Phys Med Rehabil 1996;77:1161-6.
49. Hong C, Kuan T, Chen J, Chen S. Referred pain elicited by palpation and by needling of myofascial trigger points: a comparison. Archives of Physical Medicine & Rehabilitation. 78(9):957-60, 1997 Sep.
50. Hong C. Lidocaine injection versus dry needling to myofascial trigger point. The importance of the local twitch response. Am J Phys Med Rehabil 1994;73:256-63.
51. Hong C. Myofascial trigger points: pathophysiology and correlation with acupuncture points. Acupunct Med 2000;18:41–7.
52. Hong C. New trends in myofascial pain syndrome. Zhonghua Yi Xue Za Zhi (Taipei) 2002;65:501–12.
53. Hong C. Pathophysiology of myofascial trigger point. J Formos Med Assoc 1996;95:93–104.
54. Hong C. Persistence of local twitch response with loss of conduction to and from the spinal cord. Arch Phys Med Rehabil 1994;75:12–6.
55. Hong C, Simons D. Response to treatment for pectoralis minor myofascial pain syndrome after whiplash. J Musculoskeletal Pain 1993;1:89–131.
56. Hong C, Simons D. Pathophysiologic and electrophysiologic mechanisms of myofascial trigger points. Archives of Physical Medicine & Rehabilitation. 79(7):863-72, 1998 Jul.
57. Hong C, Torigoe Y. Electrophysiologic characteristics of localized twitch responses in responsive bands of rabbit skeletal muscle fibers. J Musculoskeletal Pain 1994;2:17–43.
58. Hong C, Torigoe Y, Yu J. The localized twitch responses in responsive bands of rabbit skeletal muscle fibers are related to the reflexes at spinal cord level. J Musculoskeletal Pain 1995;3:15–33.
59. Hong C. Treatment of myofascial pain syndrome. Current Pain & Headache Reports. 10(5):345-9, 2006 Oct.
60. Hopwood M, Abram S. Factors associated with failure of trigger point injections. Clin J Pain 1994;10:227-34.
61. Hou C, Tsai L, Cheng K, et al. Immediate effects of various physical therapeutic modalities on cervical myofascial pain and trigger-point sensitivity. Archives of Physical Medicine & Rehabilitation. 83(10):1406-14, 2002 Oct.
62. Hsueh T, Cheng P, Kuan T, Hong C. The Immediate Effectiveness of Electrical Nerve Stimulation and Electrical Muscle Stimulation on Myofascial Trigger Points. American Journal of Physical Medicine & Rehabilitation. 1997;76(6):471-476.
63. Hsueh T, Yu S, Kuan T, et al: Association of active myofascial trigger points and cervical disc lesion. J Formos Med Assoc 1998;97:174–80.
64. Hubbard D, Berkoff G. Myofascial trigger points show spontaneous needle EMG activity. Spine 1993;18:1803–7.
65. Imamura S, Fischer A, Imamura M, Teixeira, et al. Pain management using myofascial approach when other treatment failed. Phys Med Rehabil Clin North Am 1997;8:179-96.
66. Kuan T, Chang Y, Hong C. Distribution of active loci in rat skeletal muscle. J Musculoskeletal Pain 1999;7:45–54.
67. Kuan T, Chen J, Chen S, et al. Effect of botulinum toxin on endplate noise in myofascial trigger spots of rabbit skeletal muscle. American Journal of Physical Medicine & Rehabilitation. 81(7):512- 20; quiz 521-3, 2002 Jul.
68. Lavelle E, Lavelle W, Smith H. Myofascial trigger points. Anesthesiology Clinics. 25(4):841-51, vii- iii, 2007 Dec.
69. Lee S, Chen C, Lee C, et al. Effects of needle electrical intramuscular stimulation on shoulder and cervical myofascial pain syndrome and microcirculation. Journal of the Chinese Medical Association: JCMA. 71(4):200-6, 2008 Apr.
70. Lewis J, Tehan P. A blinded pilot study investigating the use of diagnostic ultrasound for detecting active myofascial trigger points. Pain. 79(1):39-44, 1999 Jan.
71. Lewit K. The needle effect in relief of myofascial pain. Pain 1979;6:83–90.
72. Ling F, Slocumb J. Use of trigger point injections in chronic pelvic pain. Obstet Gynecol Clin North Am 1993;20:809-15.
73. Majlesi J, Unalan H. High-power pain threshold ultrasound technique in the treatment of active myofascial trigger points: a randomized, double-blind, case-control study. Archives of Physical Medicine & Rehabilitation. 85(5):833-6, 2004 May.
74. Melzack R. Myofascial trigger points: relation to acupuncture and mechanism of pain. Arch Phys Med Rehabil 1981;62:114–7.
75. Mense S, Schmit R. Muscle pain: which receptors are responsible for the transmission of noxious stimuli? In: Rose F, ed. Physiological aspects of clinical neurology. Oxford: Blackwell Scientific Publications, 1977:265-78.
76. Mense S. Considerations concerning the neurobiological basis of muscle pain. Can J Physiol Pharmacol 1991;69:610–6.
77. Mense S. Nociception from skeletal muscle in relation to clinical muscle pain. Pain 1993;54:241–89.
78. Mense S. Peripheral mechanisms of muscle nociception and local muscle pain. J Musculosketal Pain 1993;1:133–70.
79. Mense S. Referral of muscle pain: new aspects. Am Pain Soc J 1994;3:1–9.
80. Meyer H. Myofascial pain syndrome and its suggested role in the pathogenesis and treatment of fibromyalgia syndrome. Current Pain & Headache Reports. 6(4):274-83, 2002 Aug.
81. Myburgh C, Larsen AH Hartvigsen J. A systematic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. Archives of Physical Medicine & Rehabilitation. 89(6):1169-76, 2008 Jun.
82. Ohrbach R, Gale E: Pressure pain thresholds in normal muscles: reliability, measurement effects and topographic differences. Pain 1989;37:257–63.
83. Ohrbach R, Gale E: Pressure pain thresholds, clinical assessment, and differential diagnosis: reliability and validity in patients with myofascial pain. Pain 1989;39:157–69.
84. Rachlin E. History and physical examination for regional myofascial pain syndrome. In: Rachlin ES, ed. Myofascial pain and fibromyalgia: trigger point management. St. Louis: Mosby, 1994:159-72.
85. Rachlin E. Trigger points. In: Rachlin E, ed. Myofascial pain and fibromyalgia: trigger point management. St. Louis: Mosby, 1994:145-57.
86. Reeves J, Jaeger B, Graff-Radford S: Reliability of the pressure algometer as a measure of myofascial trigger point sensitivity. Pain 1986;24:313–21.
87. Ruoff G. Technique of trigger point injection. In: Pfenninger J, Fowler G, eds. Procedures for primary care physicians. St. Louis: Mosby, 1994:164-7.
88. Sciotti V, Mittak V, DiMarco L, Fet al. Clinical precision of myofascial trigger point location in the trapezius muscle. Pain. 93(3):259-66, 2001 Sep.
89. Shah J, Danoff J, Desai M, et al. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Archives of Physical Medicine & Rehabilitation. 89(1):16-23, 2008 Jan.
90. Simons D, Hong C, Simons L: Endplate potentials are common to midfiber myofascial trigger points. Am J Phys Med Rehabil 2002;81:212–22.
91. Simons D, Hong C, Simons L: Prevalence of spontaneous electrical activity at trigger spots and at control sites in rabbit skeletal muscle. J Musculoskeletal Pain 1995;3:35–48.
92. Simons D. Cardiology and Myofascial Trigger Points: Janet G. Travell's Contribution . Tex Heart Inst J. 2003; 30(1): 3–7.
93. Simons D: Clinical and etiological update of myofascial pain from trigger points. J Musculoskeletal Pain 1996;4:93–121.
94. Simons D. New views of myofascial trigger points: etiology and diagnosis. Arch Phys Med Rehabil 2008;89(1): 157–9.
95. Simons D, Travell J, Simons L. Travell & Simons' Myofascial pain and dysfunction: the trigger point manual. 2d ed. Baltimore: Williams & Wilkins, 1999.
96. Smith-Fassler M, Lopez-Bushnell K: Acupuncture as complementary therapy for back pain. Holist Nurs Pract 2001;15:35–44.
97. Sola A, Bonica J. Myofascial pain syndromes. In: Bonica JJ, ed. The management of pain. 2d ed. Philadelphia: Lea & Febiger, 1990:352-67.
98. Srbely J, Dickey J. Randomized controlled study of the antinociceptive effect of ultrasound on trigger point sensitivity: novel applications in myofascial therapy?. Clinical Rehabilitation. 21(5):411-7, 2007 May.
99. Trinh K, Phillips S, Ho E, et al: Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. Rheumatology (Oxford) 2004;43:1085–90.
100. Workloss Data Institute. Official Disability Guidelines.
101. Yunus M. Fibromyalgia syndrome and myofascial pain syndrome: clinical features, laboratory tests, diagnosis, and pathophysiologic mechanisms. In: Rachlin E, ed. Myofascial pain and fibromyalgia: trigger point management. St. Louis: Mosby, 1994:3-29.
102. Zaralidou A, Amaniti E, Maidatsi P, et al. Comparison between newer local anesthetics for myofascial pain syndrome management. Methods & Findings in Experimental & Clinical Pharmacology. 29(5):353-7, 2007 Jun.
103. Zohn D, Mennell J. Musculoskeletal pain: diagnosis and physical treatment. Boston: Little, Brown, 1976:126-9,190-3.
Codes:
(The list of codes is not intended to be all-inclusive and is included below for informational purposes only. Inclusion or exclusion of a procedure, diagnosis, drug or device code(s) does not constitute or imply authorization, certification, approval, offer of coverage or guarantee of payment.)
CPT*
HCPCS
* CPT only copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
_________________________________________________________________________________________
Medical policies can be highly technical and are designed for use by the Horizon BCBSNJ professional staff in making coverage determinations. Members referring to this policy should discuss it with their treating physician, and should refer to their specific benefit plan for the terms, conditions, limitations and exclusions of their coverage.
The Horizon BCBSNJ Medical Policy Manual is proprietary. It is to be used only as authorized by Horizon BCBSNJ and its affiliates. The contents of this Medical Policy are not to be copied, reproduced or circulated to other parties without the express written consent of Horizon BCBSNJ. The contents of this Medical Policy may be updated or changed without notice, unless otherwise required by law and/or regulation. However, benefit determinations are made in the context of medical policies existing at the time of the decision and are not subject to later revision as the result of a change in medical policy
____________________________________________________________________________________________________________________________ |