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Dry Needling Victory










Corporate Medical Policy
Page
1
of
3
An Independent Licensee of the Blue Cross and Blue Shield Association
Dry
Needling of Myofascial Trigger Points
“Notification”
File Name:
dry_needling_of_myofascial_trigger_points
07/2016
N/A
02/2017
07/2016
Origination:
Last CAP Review:
Next CAP
Review:
Last Review:
Policy Effective August 30
, 2016
Description of Procedure or Service
Trigger points are discrete, focal, hyperirritable spots within a taut band of skeletal muscle fibers
that
produce local and/or referred pain when stimulated.
Dry needling refer
s to a procedure whereby
a fine
needle is inserted into the trigger point to induce a twitch response and relieve the pain
.
Dry needling refers to a procedure in which a fine needle is inserted into the skin and muscle at a
site of
myofascial pain. The needle may be moved in an up
-and
-down motion, rotated, and/or left in
place for as
long as 30 minutes. The intent is to stimulate underlying myofascial trigger points,
muscles, and
connective tissues to manage myofascial pain. Dry need
ling may be performed with
acupuncture needles
or standard hypodermic needles, but is performed without the injection of
medications (e.
g., anesthetics,
corticosteroids). Dry needling is proposed to treat dysfunctions in
skeletal muscle, fascia, and connec
tive
tissue; diminish persistent peripheral pain; and reduce
impairments of body structure and function.
The physiological basis for dry needling depends on the targeted tissu
e and treatment objectives.
The
most studied targets are trigger points. Trigger
points are discrete, focal, hyp
erirritable spots
within a taut band of skeletal muscle fibers that produce local and/or referred pain when
stimulated.
Trigger points are associated with local ischemia and hypoxia, a significantly lowered p
H, local and
ref
erred pain, and alter
ed muscle activation patterns. Trigger points can be visualized by
magnetic
resonance imaging and elastography. Reliability of manual identification of trigger points has not
been established.
Deep dry needling is believed to inactiv
ate trigger points by eliciting contraction and subsequent
relaxation of the taut band via a spinal cord reflex. This local twitch res
ponse is defined as a
transient
visible or palpable contraction or dimpling of the muscle, and has been
associated with
alleviation of
spontaneous electrical activity; reduction of numerous nociceptive, inflammatory, and
immune system related chemicals; and relaxation of the taut band. Deep dry needling of trigger
points is believe
d to reduce local and referred pain, improve range of motion, and decrease trigger
point irritability.
Superficial dry needling is thought to activate mechanoreceptors and have an indirect effect on pain
by
inhibiting C
-fiber pain impulses. The physiological basis for dry needling treatment of exces
sive
muscle
tension, scar tissue, fascia, and connective tissues is not as well described in the literature.
Alternative nonpharmacologic treatment modalities for tr
igger point pain include manual
techniques,
massage, acupressure, ultrasonography, application of heat or ice, diathermy,
transcutaneous electrical
nerve stimulation, and spray cooling with manual stretch.
Page
2
of
3
An Independent Licensee of the Blue Cross and Blue Shield Association
Dry
Needling of Myofascial Trigger Points
“Notification”
Dry needling is considered a procedure and, as such, is not subject to regulation by the U.S. Food
and
Drug Administration
.
***Note: This Medical Policy is complex and technical. For questions concerning the technica
l
language
and/or specific clinical indications for its use, please consult your physician.
Policy
Dry needling of trigger points for the treatment of myofascial pain is
considered
investigational
is considered investigational for all applications. BCBSNC does not provide
coverage for investigational services or procedures.
Benefits Applicatio
n
This medical policy relates only to the servic
es or supplies described
herein
. Please refer to the Member's
Benefit Booklet for availability of benefits. Member's benefits may vary according to benefit design;
therefore member benefit language should be reviewed before applying the terms of this medical policy.
When
Dry
Needling of Myofascial Trigger Points
is covered
Not applicable.
When
Dry Needling of Myofascial Trigger Points
is not covered
Dry needling of trigger points for the treatment of myofascial pain is considered investigational
.
Policy Guidelines
For individuals who have trigger points associated with myofascial p
ain who receive dry needling
of
trigger points, the evidence includes a number of randomized controlled
trials and systematic
reviews. Relevant outcomes are symptoms, functional outcomes, quality of life, a
nd treatment
-
related morbidity. Overall, dry needling of trigger points has not been shown to be clinicall
y
superior to sham treatment or
manual therapy. In addition, dry needling is associated with a high
incide
nce of mild adv
erse events. The evidence is insufficient to determine the effects of the
technology on health outcomes.
Billing
/Coding/Physician Documentation Information
This policy may apply to the following codes. Inclusion of a code in this section does not
guarantee that it
will be reimbursed. For further information on reimbursement guidelines, please see Administrative
Policies on the Blue Cross Blue Shield of North Carolina web site at www.bcbsnc.com. They are listed in
the Category Search on the Medical Policy search page.
Applicable codes
:
There is currently no specific CPT code for dry needling. The AMA CPT i
nstructs that
the unlisted code
20999 should be used for the dry needling procedure. Because dry needling is not
acupuncture, CPT codes
97810
-97814 are not appropriate.
BCBSNC may request medical records for determination of medical necessity. When medical records are
requested, letters of support and/or explanation are often useful, but are not sufficient documentation unless all
specific information needed to make a medical necessity determination is included.
Scientific Background and Reference Sources
BCBSA Medical Policy Reference Manual [Electronic Version].
2.01.100
,
5/19
/2016

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