150 North Wacker Drive
Suite 2360
Chicago, IL 60606
847-381-5465 Phone
847-381-4606 Fax

User Information

Create New Account

Lost Password


Quick Links

LCDs and LCAs
by Contractor

PLA Codes

Laboratory Fee Schedule


Physician Fee Schedule


OPPS Fee Schedule


ASC Fee Schedule


APC Codes


DRG Codes


ASP Drug Pricing Files


CMS Transmittals

CodeMap® LCD-L36859


Printer Friendly Version

LCD for Trigger Point Injections (TPI) (L36859)
See related Articles:
A55473-Response to Comments: Trigger Point Injections
A57702-Billing and Coding: Trigger Point Injections (TPI)
A59652-Response to Comments: Trigger Point Injections (TPI)

Contractor Information

Contractor Name: Noridian Healthcare Solutions, LLC - Full list of policies of this Medicare Contractor

Contractor Number: 03302

Contractor Type: MAC B

LCD Information

LCD ID Number: L36859 Status: A-Approved

LCD Title: Trigger Point Injections (TPI)

Geographic Jurisdiction: North Dakota Other Jurisdictions

Original Determination Effective Date: 05/26/2017

Original Determination Ending Date:

Revision Effective Date: 04/01/2024

Revision End Date:

CMS National Coverage Policy:

Italicized font represents CMS national language/wording copied directly from CMS Manuals or CMS Transmittals. Contractors are prohibited from changing national language/wording.

Title XVIII of the Social Security Act, §1862(a)(1)(A) allows coverage and payment for only those services that are considered to be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Title XVIII of the Social Security Act, §1862(a)(1)(D) Investigational or Experimental

IOM Citations:

  • CMS IOM Publication 100-08, Medicare Program Integrity Manual,

~ Chapter 13, 13.5.4 Reasonable and Necessary Provision in an LCD

Social Security Act (Title XVIII) Standard References:

  • Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.
  • Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.

Code for Federal Regulations (CFR) References:

CFR, Title 42, Ch. IV, §410.74 Physician assistant's services, §410.75 Nurse practitioner's services and §410.76 Clinical nurse specialist's services.


NCD 30.3.3 Acupuncture for Chronic Low Back Pain

Sorry, you need to login or register to view additional sections of this Medicare policy.


All information on this web site is compiled directly from information obtained from the Center for Medicare and Medicaid Services (CMS) and from its Contractors.

CodeMap® has made every reasonable effort to ensure the accuracy of the information contained on this web site. However, the ultimate responsibility for correct coding and claims submission lies with the provider of services. CodeMap® makes no representation, warranty, or guarantee that this compilation of Medicare information is error-free or that the use of this information will result in Medicare coverage and subsequent payment of claims. Final coverage and payment of claims are subject to many factors exclusively controlled by CMS and its contractors.

No part of this web page or data displayed may be redistibuted or used without the express written consent of Wheaton Partners, LLC.

07/17/2024 08:11:43

CodeMap® is a Registered Trademark of Wheaton Partners, LLC.