Musculoskeletal Assessment Systems
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Defines Aetna's coverage stance for computerized and wearable musculoskeletal assessment systems (e.g., Metrecom skeletal analysis, FIGUR8 Advanced Musculoskeletal Assessment System) for evaluation, screening, and rehabilitation. Applies to providers submitting claims for these systems and related CPT/ICD-10 codes.
No material clinical or coverage changes in this revision.
Coverage Determinations
Experimental and Investigational
Aetna considers the following experimental and investigational:
Individual components of these analyses are also considered experimental and investigational.
Individual components of computerized, biomechanical, or digital skeletal analyses are considered experimental and investigational. Aetna specifically notes that the value of these analyses in improving clinical outcomes has not been established, and therefore both the overall systems and their individual components are classified as experimental/investigational and not covered for the listed indications.
Use of the Metrecom skeletal analysis system or other computerized, biomechanical, or digital skeletal analysis systems is considered not medically necessary (experimental/investigational) because effectiveness in improving clinical outcomes has not been established.
The FIGUR8 Advanced Musculoskeletal Assessment System is considered experimental and investigational when used for neuromuscular control screenings for injury prevention and rehabilitation because there is insufficient evidence demonstrating clinical value or improved outcomes.
Coding References
| 0778T | Surface mechanomyography (sMMG) with concurrent application of inertial measurement unit (IMU) sensors for measurement of multi-joint range of motion, posture, gait, and muscle function. |
| 95851 | Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine). |
| 97750 | Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes. |
| M00.00 - M99.9 | Diseases of the musculoskeletal system and connective tissue. |
| S00.00x+ - T14.91 | Injury. |
| Z13.820 - Z13.828 | Encounter for screening for musculoskeletal disorders [for neuromuscular control screenings for injury prevention and rehabilitation]. |
| Z13.850 - Z13.858 | Encounter for screening for nervous system disorders [for neuromuscular control screenings for injury prevention and rehabilitation]. |
Provider Billing & Documentation Actions
Provider documentation required
Provide complete clinical documentation demonstrating how the member meets all applicable policy selection criteria when submitting claims. Include clinical findings, test results, functional assessments, and a written report tying the service to medical necessity.
Denial risk for experimental/investigational systems
Claims for Metrecom and other computerized/biomechanical/digital skeletal analysis systems are considered experimental and investigational and are subject to denial.
- Examples: Metrecom skeletal analysis system, FIGUR8 Advanced Musculoskeletal Assessment System
- Individual components of these analyses are also considered experimental/investigational
Background
The Metrecom system is a non‑invasive, electromechanical digitizer designed to record palpated body landmarks with a touch probe and linkage arm to produce three‑dimensional measurements used for postural and spinal assessment, including range of motion and Cobb angle analysis. The policy states that use of Metrecom and similar computerized/biomechanical/digital skeletal analysis systems is considered experimental/investigational because their effectiveness for improving clinical outcomes has not been established.
Definitions
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