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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules state that trigger point injection is one of the many modalities utilized in the management of chronic 
pain. Myofascial trigger points are self-sustaining hyperirritative foci that may occur in any skeletal muscle in 
response to strain produced by acute or chronic overload. These trigger points produce a referred pain pattern 
characteristic for that individual muscle. Production of a referred pain pattern differentiates myofascial pain 
syndrome from tender points and fibromyalgia. Each pattern becomes part of a single muscle myofascial pain 
syndrome (MPS); and each of these single muscle syndromes is responsive to appropriate treatment, which 
includes injection therapy. Injection is achieved with needle insertion and the administration of agents such as 
local anesthetics. 
 
Indications: 
 
The diagnosis of trigger points requires a detailed history and thorough physical examination. The following 
clinical features are present most consistently, and are helpful in making the diagnosis: 
 
    History of onset of the painful condition, and its presumed cause (injury, sprain, etc.); 
    Distribution pattern of pain consistent with the referral pattern of the trigger points; 
    Restriction of range of motion with increased sensitivity to stretch; 
    Muscular deconditioning in the affected area; 
    Focal tenderness of a trigger point; 
    Palpable taut band of muscle in which trigger point is located; 
    Local taut response to snapping palpation or needle insertion; and 
    Reproduction of referred pain pattern upon stimulation of the trigger point. 
 
The goal is to treat the cause of the pain and not just the symptom of pain. Other treatment modalities include: 
 
    Pharmacologic treatment including analgesics and medications to induce sleep and relax muscles (i.e. 
antidepressants, neuroleptics, or non steroidal anti-inflammatory drugs); and 
    Nonpharmacologic treatment modalities (i.e., osteopathic manual medicine techniques, massage, 
ultrasonography, application of heat or ice, transcutaneous electrical nerve stimulation, Spray and Stretch 
technique); and 
    For trigger points in the acute state of formation (before additional pathologic changes develop), effective 
treatment may be delivered through physical therapy. 
 After myofascial pain syndrome is established as described above, trigger point injection may be indicated 
when noninvasive medical management is not successful or as first line treatment. Additionally, trigger point 
injection is indicated when the movement of a joint is mechanically blocked as is the case of the coccygeus 
muscle. 
 
Limitations: 
 
Only one trigger point injection procedure should be reported on any particular day, no matter how many sites 
or regions are injected. 
 
The local anesthetic administered in conjunction with trigger point injections is included in the practice 
expense for these procedures. 
 
Trigger point injections used on a routine basis, e.g., on a regular periodic and continuous basis, for patients 
with chronic non-malignant pain syndromes are not considered medically necessary. 
 
Only injections of local anesthetics and corticosteroids are covered. Injections consisting of only saline and/or 
botanical substances are not supported in the peer-reviewed literature and are not considered medically 
necessary. Prior to January 21, 2020, dry needling is not a covered service. Effective January 21, 2020, 
Medicare will cover all types of acupuncture including dry needling for chronic low back pain within specific 
guidelines in accordance with NCD 30.3.3. 
 
You can find this information in the Local Coverage Determination (LCD) Pain Management L33622. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.