HCPCS and related codes for traction devices are identified in the policy. Notably, E0830 is listed for ambulatory traction devices, L0631 is listed for a lumbar‑sacral orthosis (sagittal control), and S9090 is listed for vertebral axial decompression (per session; e.g., Triton DTS). The policy also references CPT procedure codes commonly used with traction services such as 97012 (mechanical traction) and 97140 (manual therapy techniques, including manual traction).

The policy explicitly notes that certain HCPCS-coded devices (examples given include the Z‑Grav spinal decompression table, lumbar lordotic curve‑controlled traction devices, and inversion tables such as the Fit Spine LX9) are not covered for the indications listed in this Clinical Policy Bulletin; use or billing for these devices may be subject to denial because effectiveness has not been established.

A randomized study of lordotic curve‑controlled traction (Lee et al.) had several important limitations described by the authors. Although enrollment met sample‑size targets, the study population was narrowly defined and may not generalize to broader age groups or disease severities. There was no control group of patients without disc disease, and outcomes were assessed immediately after a course of therapy (final measurement at ~15 sessions, about 1.5 months), so the trial did not provide data on durable, long‑term benefit. The authors conclude that the long‑lasting effects of traction remain undetermined and should be assessed in future studies.

Systematic reviews and authoritative assessments consistently conclude that the available evidence does not demonstrate traction to be effective for acute or chronic low back pain. Earlier technology assessments and guidelines (for example, the Norwegian Centre for Health Technology Assessment and AHCPR guideline) reported no demonstrated benefit for traction in lumbar disc herniation or acute LBP. More recent systematic reviews, including a Cochrane review, found that traction is probably not effective overall and that neither continuous nor intermittent traction alone was superior to placebo, sham, or other treatments for mixed‑duration low back pain with or without sciatica. Some reviews noted isolated findings (for example, limited evidence that autotraction may be superior to mechanical traction in certain sciatica outcomes), but these results were inconsistent and based on studies with methodological limitations.

Traction is widely used in the management of low back pain in multiple forms and modes, including mechanical traction, manual traction, autotraction (use of the patient’s own weight), gravity‑dependent or axial unloading devices, pneumatic systems, and continuous or intermittent application. Its proposed mechanisms—such as spinal elongation, reduction of lordosis, or increased intervertebral space—have been offered, but empirical support is limited. Traction is commonly administered in combination with other therapies, and supervised mechanical traction is typically provided up to 4 sessions per week in clinical practice.