Trigger point injections are not administered in isolation, but are provided as part of a comprehensive pain management program, including physical therapy, patient education, psychosocial support, and oral medication where appropriate.Trigger points have been identified by palpation and Of corticosteroids and/or local anesthetics are considered medically necessary for treating members with chronic neck or back pain or myofascial pain syndrome, when all of the following selection criteria are met: Facet joint injections are considered experimental and investigational as therapy for back and neck pain and for all other indications because their effectiveness for these indications has not been established.įacet joint injections (intra-articular and medial branch blocks) containing corticosteroids are considered therapeutic injections. Aetna considers diagnostic facet joint injections not medically necessary where radiofrequency facet neurolysis is not being considered.Īdditional sets of facet injections or medial branch blocks at the same levels and side are considered experimental and investigational because they have no proven value.Īetna considers ultrasound guidance of facet injections experimental and investigational because of insufficient evidence of its effectiveness. If the initial injection did not produce a positive response, a second diagnostic injection is considered not medically necessary.ĭiagnostic facet joint injections are considered experimental and investigational for neck and back pain with untreated radiculopathy. These may be performed bilaterally during the same session for a total of up to six injections.Ī second diagnostic facet injection (intraarticular and medial branch block) is considered medically necessary to confirm the validity of the clinical response to the initial facet injection when it is administered at the same level as the initial facet injection, and where the initial facet injection produced a positive response (i.e., resulted in an 80% relief of facet mediated pain for at least the expected minimum duration of the effect of the local anesthetic). Injection of no more than three (3) facet joint levels are considered medically necessary during the same session/procedure.
An initial facet injection (intra-articular and medial branch block) from C2-3 to L5-S1 is considered medically necessary for the diagnosis of facet pain in persons with severe chronic neck and back pain that limits daily activities and has lasted more than 3 months despite six or more weeks of conservative treatment (including, systemic medications, and/or physical therapy), with symptoms suggestive of facet joint syndrome (symptoms of facet joint syndrome include absence of radiculopathy, pain that is aggravated by extension, rotation or lateral bending of the spine and is not typically associated with any neurological deficits), where facet mediated pain is confirmed by provocative testing on physical examination (to confirm that pain is exacerbated by extension and rotation), imaging studies suggest no other obvious cause of pain (such as fracture, tumor, infection, or significant extraspinal lesion), and radiofrequency facet neurolysis is being considered.
Aetna considers any of the following injections or procedures medically necessary for the treatment of back pain provided, however, that only one invasive modality or procedure will be considered medically necessary at a time.
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