Does Medicare Cover Trigger Point Injections?

• by Christian Worstell
• October 27, 2021

Medicare covers trigger point injections and a number of other pain management treatments, products and services.

Trigger point injections are typically covered by Medicare Part B, and because Medicare Advantage (Medicare Part C) plans are required to cover at least everything Medicare Part B and Part A cover, Medicare Advantage plans may also cover trigger point injections.

When does Medicare pay for trigger point injections?

A Medicare beneficiary must be diagnosed with myofascial pain syndrome (MPS), which is a chronic pain disorder, in order for Medicare to cover trigger point injections.

A doctor or provider will review the beneficiary’s medical history and complete an exam of the patient to make this diagnosis. Some of the things a doctor will consider when making such a diagnosis may include:

• Previous injuries to the area affected by the pain
• Restricted range of motion
• A deconditioning of the muscle and focal tenderness
• Taut bands of muscle and a localized response to a snapping palpation
• Being able to reproduce the pain pattern when the trigger point is stimulated and a distribution of pain that is consistent with the referral patterns of certain trigger points

After an MPS diagnosis is confirmed, the trigger point injection must be deemed medically necessary for Medicare to cover the injections.

Medicare typically determines a trigger point injection to be medically necessary if joint movement is mechanically blocked, non-invasive medical management has been attempted unsuccessfully or other treatments such as physical therapy or medications are being initiated. 

How much do trigger point injections cost with Medicare?

When covered by Medicare Part B, beneficiaries receiving trigger point injections are generally responsible for a 20% coinsurance of the Medicare-approved amount after meeting their annual Part B deductible. The coinsurance requirement can be covered by some types of Medicare Supplement Insurance (Medigap) plans.

If you have a Medicare Advantage plan, your coinsurance amount for trigger point injections may be different than the typical 20% Medicare Part B coinsurance, and your annual deductible may vary as well. All Medicare Advantage plans are required by law to cover trigger point injections, but the cost amounts you’re responsible to pay may differ from plan to plan. 

Medicare typically regards each spot on the body that receives a trigger point injection as one service rendered, regardless of how many injections are made at the site. 

Does Medicare cover prolotherapy and other pain management?

Two procedures that are similar to trigger point injections are prolotherapy and acupuncture. 

• Prolotherapy works just like a trigger point injection. However, while trigger point injections deliver local anesthetics, steroids or inflammatory drugs to the affected area, prolotherapy uses natural irritants in an attempt to elicit a healing response from the body.
  
  Prolotherapy is considered alternative medicine and its effectiveness remains in dispute. Prolotherapy is not covered by Medicare. 
  
  
• Acupuncture does not deliver any outside agents to the body. Only the needle itself is injected. After years of not covering acupuncture, Medicare Part B recently added acupuncture to its list of covered benefits. Part B will cover up to 12 acupuncture sessions in a 90-day period when used to address chronic lower back pain. If improvement is shown, Medicare will cover an additional 8 sessions, but no more than 20 total sessions in a year’s time. 
  
  All Medicare Advantage plans cover acupuncture, and some may offer additional coverage on top of what is covered by Medicare Part B.  

You can compare Medicare Advantage plans online for free, with no obligation to enroll. You can also call to speak with a licensed insurance agent who can help you review the Medicare Advantage plans available where you live and discuss how they may be able to help cover your pain management treatments. 

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.

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