CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Dry Needling of Trigger Points for Myofascial Pain

Policy for Commercial Products defining coverage determination for dry needling of myofascial trigger points (not applicable to Medicare Advantage). It states medical necessity conclusions, applicable CPT coding guidance, and cites supporting evidence.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyDry Needling of Trigger Points for Myofascial Pain

Policy CodePolicy N/A

Change Typeclarified

Effective DateJun 21, 2016

Next Review Date

Key ActionRefer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable coverage details.

POLICY UPDATE CHANGES

Policy is applicable to Commercial Products only; Medicare Advantage plans have a related policy.

Not medically necessaryCoverage determination

2CPT codes listed as not medically necessary

97810-97814Codes explicitly inappropriate to bill

Coverage Summary

Overview: This policy addresses dry needling of myofascial trigger points for Commercial Products. The policy scope defines the coverage determination for dry needling and related CPT coding guidance, and concludes that dry needling of trigger points for treatment of myofascial pain is not medically necessary for Commercial Products because the evidence is insufficient to determine effects on health outcomes. Effective date: 06/21/2016. Last review date: 05/06/2026. Note: Policy is applicable to Commercial Products only; Medicare Advantage readers are referred to the related policy named Acupuncture and Dry Needling for Medicare Advantage Plans.

Commercial Products Coverage Determination

Covered when ALL of the following are met:

Dry needling of trigger points for the treatment of myofascial pain is considered not medically necessary for Commercial Products because the evidence is insufficient to determine effects on health outcomes.

This is the dispositive coverage statement for Commercial Products.

Medical-Necessity and Prior Authorization

Medical Criteria

Policy medical criteria applicability

Medical criteria: Not applicable

Prior Authorization

Policy prior authorization applicability

Prior authorization: Not applicable

Provider Actions & Billing Impact

Documentation Required

Refer to benefit booklet/contract

Benefits may vary between groups and contracts; providers must refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable coverage details.

Benefits vary by group/contract

Billing Rule

Do not bill acupuncture codes for dry needling

Do not report CPT codes 97810-97814 for dry needling services because dry needling is not acupuncture.

97810-97814

Denial Risk

Claims for dry needling may be denied

Dry needling of trigger points for myofascial pain is considered not medically necessary for Commercial Products and claims may be denied on that basis.

20560
20561

Background and Evidence Summary

Background: Dry needling inserts fine needles into myofascial trigger points to relieve pain; trigger points are discrete, focal, hyperirritable spots within a taut band of skeletal muscle fibers that produce local and/or referred pain when stimulated.

Rationale and reliability: The physiologic rationale includes eliciting a local twitch response with deep dry needling (believed to inactivate trigger points via a spinal reflex, reduce nociceptive mediators, and relax the taut band) and activation of mechanoreceptors with superficial dry needling to indirectly inhibit C-fiber pain impulses. Scope note: the reliability of manual identification of trigger points has not been established.

Condition/Study	Evidence Summary
Neck/shoulder pain systematic reviews and RCTs	Evidence insufficient; systematic reviews and RCTs found dry needling not greater than placebo and not associated with clinically important reductions compared with other physical therapy modalities; overall evidence insufficient to determine improvement in net health outcome.
Plantar heel pain systematic review	Mixed results from a systematic review of 6 RCTs (395 patients); no overall difference in pain vs controls but some improvements after ≥3 sessions and for long-term pain and disability; evidence rated low to moderate and overall insufficient.
Temporomandibular myofascial pain RCT	One double-blind, sham-controlled RCT found no significant differences in pain or function one week after intervention (though higher pain pressure threshold in treatment group); evidence insufficient.

Myofascial trigger points: Discrete, focal, hyperirritable spots within a taut band of skeletal muscle fibers that produce local and/or referred pain when stimulated.

Dry needling: A procedure inserting a fine needle into the skin and muscle at a site of myofascial pain without injection of medications to stimulate trigger points and manage pain.

Local twitch response: A transient visible or palpable contraction or dimpling of the muscle associated with alleviation of spontaneous electrical activity.

Revision History

06|21|2016effective

Policy effective date: 06/21/2016.

05|06|2026last_reviewLatest

Policy last reviewed: 05/06/2026.

clarificationLatest

Policy is applicable to Commercial Products only; Medicare Advantage readers are referred to the related policy 'Acupuncture and Dry Needling for Medicare Advantage Plans'.

coverage_changeLatest

codingLatest

CPT codes 20560 and 20561 are listed as not medically necessary for Commercial Products; CPT codes 97810-97814 (acupuncture codes) are not appropriate to be used for dry needling services.

administrativeLatest

Medical criteria: Not applicable; Prior authorization: Not applicable.