Medical Policy: 08.01.31 

Original Effective Date: November 2018 

Reviewed: November 2020 

Revised: November 2020 

 

Notice:

This policy contains information which is clinical in nature. The policy is not medical advice. The information in this policy is used by Wellmark to make determinations whether medical treatment is covered under the terms of a Wellmark member's health benefit plan. Physicians and other health care providers are responsible for medical advice and treatment. If you have specific health care needs, you should consult an appropriate health care professional. If you would like to request an accessible version of this document, please contact customer service at 800-524-9242.

 

Benefit Application:

Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary based on contract, and individual member benefits must be verified. Wellmark determines medical necessity only if the benefit exists and no contract exclusions are applicable. This medical policy may not apply to FEP. Benefits are determined by the Federal Employee Program.

 

This Medical Policy document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy will be reviewed regularly and be updated as scientific and medical literature becomes available.

 

Description:

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 needling may be performed with acupuncture needles or standard hypodermic needles but is performed without the injection of medications (eg, anesthetics, corticosteroids). Dry needling, even though it targets a trigger point, also differs from a trigger point injection, as there is no injection of medication or fluid. Dry needling is proposed to treat dysfunctions in skeletal muscle, fascia, and connective tissue; diminish persistent peripheral pain, and reduce impairments of body structure and function.

 

Dry needling is almost always used as a part of an overall plan that will likely include some type of exercise, manual therapy, heat therapy, and education. Dry needling is used to increase range of motion that may be limited due to muscle tightness or scar tissue. Dry needling may also treat:

  • Joint problems
  • Disk problems
  • Tendinitis
  • Migraine and tension-type headaches
  • Jaw and mouth problems
  • Whiplash
  • Repetitive motion disorders
  • Spinal problems
  • Pelvic pain
  • Night cramps
  • Phantom pain
  • Post-herpetic neuralgia 
  • Plantar Fasciitis
  • Muscle Tension

 

Deep Dry Needling

Deep dry needling is believed to inactivate trigger points by eliciting contraction and subsequent relaxation of the taut band via a spinal cord reflex. This local twitch response 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 believed 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 excessive muscle tension, scar tissue, fascia, and connective tissues is not as well described in the literature.

 

Superficial Dry Needling

Superficial dry needling is thought to activate mechanoreceptors and have an indirect effect on pain by inhibiting C-fiber pain impulses. The physiologic basis for dry needling treatment of excessive muscle tension, scar tissue, fascia, and connective tissues is not as well described in the literature.

 

According to the American Society of Regional Anesthesia and Pain Medicine. Myofascial pain is a common, non-articular musculoskeletal disorder characterized by symptomatic myofascial trigger points - hard, palpable, localized nodules within taut bands of skeletal muscle that are painful upon compression. MPS is a chronic condition affecting the connective tissue (i.e., fascia) surrounding the muscles; sensitive points in your muscles (trigger points) cause referred pain in seemingly unrelated parts of the body. MPS typically occurs after a muscle has been contracted repetitively. The large upper back muscles are prone to developing myofascial pain, as well as the neck, shoulders, heel and temporomandibular joint.

 

Professional Guideline and Position Statements

Canadian Agency for Drugs and Technologies in Health (CADTH)

Evidence on the effectiveness of dry needling is mixed. Limited evidence suggests that wet needling (injection) is more effective than dry needling in the treatment of musculoskeletal or joint pain. Our literature search found no information on the cost-effectiveness of dry needling for patients with musculoskeletal or joint disorders, or on the cost-effectiveness of dry needling plus injection vs. injection alone for patients with these conditions. No evidence-based guidelines were identified on the use dry needling in the treatment of musculoskeletal or joint disorders. While there are some statements on this treatment issued by physiotherapy and other healthcare professional associations, these are practitioner guides outlining competencies and safe practices for providing this procedure.

 

Regulatory Status

Dry needling is considered a procedure and, as such, is not subject to regulation by the U.S. Food and Drug Administration.

 

Prior Approval:

Not applicable.

 

Policy:

For use of Dry needling in the management of Temporomandibular Joint Dysfunction (TMJ) see related medical policy

  • 02.01.21 Temporomandibular Joint Dysfunction (TMJ) Treatment

 

Dry needling is considered investigational for all indications, including, but not limited to:

  • Joint problems
  • Disk problems
  • Tendinitis
  • Migraine and tension-type headaches
  • Whiplash
  • Repetitive motion disorders
  • Spinal problems
  • Pelvic pain
  • Night cramps
  • Phantom pain
  • Post-herpetic neuralgia
  • Plantar Fasciitis
  • Muscle Tension

 

Procedure Codes and Billing Guidelines:

To report provider services, use appropriate CPT* codes, Alpha Numeric (HCPCS level 2) codes, Revenue codes and / or diagnosis codes.

  • 20560 Needle insertion(s) without injection(s); 1 or 2 muscle(s)
  • 20561 Needle insertion(s) without injection(s); 3 or more muscles

 

Selected References:

  • Dommerholt, J., Grieve, R., Layton, M., Hooks, T. (2015) An evidence-informed review of the current myofascial pain literature. Journal of Bodywork & Movement Therapies, 19, 126-137
  • American Physical Therapy Association (APTA).(2013) Educational resource paper: Description of Dry Needling in Clinical Practice. 2013; 
  • American Physical Therapy Association (APTA).(2012) Physical Therapists and the Performance of Dry Needling. 2012; 
  • American Academy of Orthopaedic Physical Therapists.(2009) AAOMPT position statement on dry needling. 2009; 
  • Canadian Agency for Drugs and Technologies in Health (CADTH). Dry needling and injection for musculoskeletal and Joint disorders: A review of the clinical effectiveness, cost-effectiveness, and guidelines. (2016) Rapid response.
  • De Meulemeester KE, Castelein B, Coppieters I, et al. Comparing trigger point dry needling and manual pressure technique for the management of myofascial neck/shoulder pain: a randomized clinical trial. J Manipulative Physiol Ther. Jan 2017;40(1):11-20. PMID 28017188.
  • American Physical Therapy Association (APTA). Educational resource paper: Description of Dry Needling in Clinical Practice. 2013;

 

Policy History:

  • November 2020 - Annual Review, Policy Revised
  • November 2019 - Annual Review, Policy Revised
  • November 2018 - New Policy

Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.

 

*CPT® is a registered trademark of the American Medical Association.