Updates to Joint Injections and Trigger Point Injections Benefit Criteria

Date: September 9, 2025

Attention: All Providers

Effective date: November 1, 2025

Call to action: Texas Children’s Health Plan (TCHP) would like inform providers that effective for dates of service on or after November 1, 2025, Texas Medicaid will change benefit criteria for joint injections and trigger point injections.

Injectable medication and the administration of medications through the intramuscular (IM), subcutaneous (SQ), or intravenous (IV) route are a benefit of Texas Medicaid.

Viscosupplementation agents include hyaluronic acid, which is injected into the knee joint to relieve pain associated with osteoarthritis.

Providers must use the following viscosupplement procedure codes to submit claims for osteoarthritis of the knee:

If a provider submits a claim for an administration code with one of the viscosupplement procedure codes without a qualifying diagnosis code, Texas Medicaid will deny the claim.

Texas Medicaid may reimburse claims for viscosupplement procedure codes that are submitted with the following approved diagnosis codes:

Trigger Point Injections

Joint injections and trigger point injections are valid only in the treatment of acute problems or the exacerbation of a chronic condition. The provider must use the AT modifier to indicate an acute condition and use modifiers LT (left) or RT (right) as appropriate.

Next steps: Providers should share this communication with their staff. 

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.texaschildrenshealthplan.org/provideralerts.