CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Manipulation Under Anesthesia (MUA)

Defines medical coverage stance for manipulation under anesthesia (MUA) for Medicare Advantage and commercial products, describing covered, not medically necessary / not covered indications, background, and coding guidance.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyManipulation Under Anesthesia (MUA)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateMay 18, 2016

Next Review Date

Key ActionCheck the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable coverage determinations.

SourceLink

POLICY UPDATE CHANGES

No material changes

1Primary CPT explicitly addressed

4Conditions considered potentially medically necessary

5Chronic indications listed as not covered/medically unnecessary

Coverage Summary

This policy defines the coverage stance for Manipulation Under Anesthesia (MUA). Scope: MUA is a series of mobilization, stretching, and traction procedures performed while the patient is sedated, sometimes followed by spinal manipulative therapy. Coverage stance: the policy is mixed — some isolated joint indications may be considered medically necessary, while spinal MUA, serial/multi-joint MUA, and manipulation performed under or after joint/epidural anesthesia for chronic spinal, sacroiliac, and pelvic pain are considered not covered (Medicare Advantage) or not medically necessary (Commercial) due to insufficient evidence. Effective date: 2016-05-18. Last reviewed: 2022-07-20. Subject: Manipulation Under Anesthesia (MUA).

Medical Necessity Criteria

Not Medically Necessary / Not Covered Indications

The following MUA procedures are considered not medically necessary (commercial) or not covered (Medicare Advantage) because evidence is insufficient:

ALL of the following

Spinal manipulation performed during the procedure with the patient under anesthesia (any spinal region: cranial, cervical, thoracic, lumbar) for treatment of chronic spinal pain
Medicare Advantage: 'not covered'; Commercial: 'not medically necessary'
Manipulation of other joints performed during the procedure with the patient under anesthesia for treatment of chronic spinal and chronic sacroiliac and pelvic pain
Medicare Advantage: 'not covered'; Commercial: 'not medically necessary'
Spinal manipulation under joint anesthesia or spinal manipulation after epidural anesthesia and corticosteroid injection for chronic spinal pain
Insufficient evidence to determine effects on health outcomes
Spinal manipulation and manipulation of other joints under anesthesia involving serial treatment sessions
Considered not covered / not medically necessary due to insufficient evidence
Manipulation under anesthesia (MUA) involving multiple body joints for treatment of chronic pain
Considered not covered / not medically necessary due to insufficient evidence

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Medically Necessary / May Be Considered

MUA may be considered medically necessary for specific isolated joint conditions:

ANY of the following

Manipulation under anesthesia for fractures
May be considered medically necessary
Manipulation under anesthesia for completely dislocated joints
May be considered medically necessary
Manipulation under anesthesia for adhesive capsulitis (e.g., frozen shoulder)
May be considered medically necessary
Manipulation under anesthesia for fibrosis of a joint that may occur following total joint replacement
May be considered medically necessary

Provider Actions

Documentation Required

Check member benefit and subscriber agreement

Benefits may vary between groups and contracts; providers must refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for applicable coverage determinations.

Benefits vary by group and contract; check member-specific documents.

Billing Rule

Do not bill 22505 for non-covered indications

CPT 22505 is listed as not covered for Medicare Advantage and not medically necessary for Commercial Products when used for the listed chronic pain/spinal indications; providers should not expect payment for those indications.

Affected code: 22505
Not covered / Not medically necessary for listed chronic spinal, sacroiliac, and pelvic pain indications.

Documentation Required

Obtain informed financial consent if proceeding with non-covered service

If services are determined to be not medically necessary or are non-covered benefits, providers may not charge the member unless the member is informed and agrees in writing in advance to continue treatment at their own expense.

Providers may not charge the member unless informed and written consent is obtained in advance.

Background & Evidence Summary

Background: MUA involves mobilization, stretching, traction, and, after sedation, may include high-velocity, short-amplitude spinal manipulative therapy. It is intended to break up fibrous and scar tissue to improve range of motion and reduce pain, and is generally performed with anesthesia or moderate sedation and an anesthesiologist in attendance.

Typical indications: MUA is an accepted treatment for isolated joint conditions such as arthrofibrosis of the knee and adhesive capsulitis (frozen shoulder), and it is also used to reduce fractures and dislocations. These isolated joint indications may be considered medically necessary in appropriate circumstances.

Limited evidence for spinal and serial/multi-joint MUA: Evidence for MUA of the spine, spinal manipulation under joint anesthesia, spinal manipulation after epidural anesthesia and corticosteroid injection, and for serial or multi-joint MUA is very limited. No randomized controlled trials have been identified for spinal MUA, and the evidence is insufficient to determine effects on health outcomes; accordingly, spinal manipulation under anesthesia, serial treatment sessions, and MUA involving multiple body joints are listed as not covered (Medicare Advantage) or not medically necessary (Commercial).

Coding note: CPT code 22505 (Manipulation of spine requiring anesthesia, any region) is listed as not covered for Medicare Advantage and not medically necessary for Commercial Products when used for the chronic spinal/multi-joint indications described above.

Evidence item	Summary
Randomized controlled trials	None identified for spinal MUA
Evidence strength	Insufficient to determine effects on health outcomes for chronic spinal, sacroiliac, pelvic pain, serial sessions, and multi-joint MUA

Definitions

Manipulation under anesthesia (MUA)A series of mobilization, stretching, and traction procedures performed while the patient is sedated (general anesthesia or moderate sedation), sometimes followed by spinal manipulative therapy.

OpenPayer

Manipulation Under Anesthesia (MUA)

Coverage Summary

Medical Necessity Criteria

Coding

Provider Actions

Background & Evidence Summary

Revision History