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.
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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:
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.
Trigger point injections can cost from $250 to $450.1 The price varies by location, the Medicare plan you have, the number of injections you receive, and which provider you choose.
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.
Two procedures that are similar to trigger point injections are prolotherapy and acupuncture.
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.
Speak with a licensed insurance agent
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
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