CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Manipulation Under Anesthesia

Defines medical coverage stance for manipulation under anesthesia (MUA) for Medicare Advantage and Commercial products, specifying indications considered not covered/not medically necessary (primarily spinal and serial/multi-joint MUA for chronic pain) and indications that may be considered medically necessary (fracture reduction, completely dislocated joints, adhesive capsulitis, post-arthroplasty fibrosis).

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyManipulation Under Anesthesia

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMay 18, 2016

Next Review Date

Key ActionClaims for spinal manipulation under anesthesia, manipulation after epidural anesthesia and corticosteroid injection, serial treatment sessions, or multi-joint MUA for chronic pain are considered not covered/not medically necessary and may be denied.

SourceLink

POLICY UPDATE CHANGES

No material clinical/coverage changes

1Explicit CPT code listed as not covered

4Indications potentially considered medically necessary

3Chronic pain MUA scenarios considered not covered/not medically necessary

Coverage Summary

Scope: Defines medical coverage stance for Manipulation Under Anesthesia (MUA) for Medicare Advantage and Commercial products, specifying indications considered not covered/not medically necessary (primarily spinal MUA for chronic spinal [cranial, cervical, thoracic, lumbar] pain, chronic sacroiliac and pelvic pain; spinal manipulation under joint anesthesia or after epidural anesthesia and corticosteroid injection; serial treatment sessions; and MUA involving multiple body joints) and indications that may be considered medically necessary (MUA for fractures, completely dislocated joints, adhesive capsulitis [eg, frozen shoulder], and fibrosis following total joint replacement).

Coverage stance: Mixed — spinal, serial-session, and multi-joint MUA for chronic pain are considered not covered / not medically necessary per the Medicare Advantage and Commercial Products criteria; MUA for specific joint or post-arthroplasty indications may be considered medically necessary.

Dates: Effective 05|18|2016; Policy last updated/last review 05|20|2026.

Medical Necessity / Coverage Criteria

Medicare Advantage - Coverage Determinations

Coverage determinations for Medicare Advantage Plans:

ALL of the following

Spinal manipulation and manipulation of other joints performed during the procedure (e.g., hip joint) with the patient under anesthesia, spinal manipulation under joint anesthesia, and spinal manipulation after epidural anesthesia and corticosteroid injection
Considered not covered for treatment of chronic spinal (cranial, cervical, thoracic, lumbar) pain and chronic sacroiliac and pelvic pain
Spinal manipulation and manipulation of other joints under anesthesia involving serial treatment sessions
Considered not covered
Manipulation under anesthesia (MUA) involving multiple body joints
Considered not covered for treatment of chronic pain
Manipulation under anesthesia for fractures, completely dislocated joints, adhesive capsulitis (eg, frozen shoulder), and/or fibrosis of a joint that may occur following total joint replacement
May be considered medically necessary

Commercial Products - Coverage Determinations

Coverage determinations for Commercial Products:

ALL of the following

Spinal manipulation and manipulation of other joints performed during the procedure (e.g., hip joint) with the patient under anesthesia, spinal manipulation under joint anesthesia, and spinal manipulation after epidural anesthesia and corticosteroid injection
Considered not medically necessary for treatment of chronic spinal (cranial, cervical, thoracic, lumbar) pain and chronic sacroiliac and pelvic pain
Spinal manipulation and manipulation of other joints under anesthesia involving serial treatment sessions
Considered not medically necessary
Manipulation under anesthesia (MUA) involving multiple body joints
Considered not medically necessary for treatment of chronic pain
Manipulation under anesthesia for fractures, completely dislocated joints, adhesive capsulitis (eg, frozen shoulder), and/or fibrosis of a joint that may occur following total joint replacement

Not Covered / Experimental

Evidence summary: The brief states that scientific evidence on spinal MUA, spinal manipulation with joint anesthesia, and spinal manipulation after epidural anesthesia and corticosteroid injection is very limited and that no randomized controlled trials have been identified for spinal MUA. Evidence on the efficacy of MUA delivered over several sessions or for multiple joints is also lacking and safety outcomes are poorly described.

Policy implication: Because the evidence is insufficient to determine effects on health outcomes, spinal MUA, serial-session MUA, and multi-joint MUA for chronic pain are considered not covered / not medically necessary in the criteria trees for both Medicare Advantage and Commercial Products.

Chronic pain MUA — Not covered / Not medically necessary

Quick reference: chronic-pain scenarios considered not covered / not medically necessary across product types.

Chronic pain MUA not covered / not medically necessary

Spinal manipulation and manipulation of other joints performed during the procedure (e.g., hip joint) with the patient under anesthesia, spinal manipulation under joint anesthesia, and spinal manipulation after epidural anesthesia and corticosteroid injection
Considered not covered (Medicare Advantage) / not medically necessary (Commercial) for chronic spinal and sacroiliac/pelvic pain
Spinal manipulation and manipulation of other joints under anesthesia involving serial treatment sessions
Considered not covered (Medicare Advantage) / not medically necessary (Commercial)
Manipulation under anesthesia (MUA) involving multiple body joints
Considered not covered (Medicare Advantage) / not medically necessary (Commercial) for treatment of chronic pain

Provider Actions

Denial Risk

Claims for spinal or multi-joint MUA for chronic pain

Claims for spinal manipulation under anesthesia, manipulation after epidural anesthesia and corticosteroid injection, serial treatment sessions, or multi-joint MUA for chronic pain are considered not covered/not medically necessary and may be denied.

22505

Documentation Required

Benefit verification

Verify member-specific benefits and coverage in the Benefit Booklet/Evidence of Coverage/Subscriber Agreement as benefits may vary by contract.

Background & Evidence

Background: Manipulation under anesthesia (MUA) involves a series of mobilization, stretching, traction procedures, and spinal manipulative therapy performed while the patient is sedated (usually with general anesthesia or moderate sedation) and is intended to break up fibrous and scar tissue to relieve pain and improve range of motion.

Historical uses: MUA has been historically used and is an accepted treatment for isolated joint conditions such as arthrofibrosis of the knee and adhesive capsulitis, and it has been used to reduce fractures and dislocations. MUA of the spine has been used in various forms since the 1930s, with revival in the 1990s related to interest in spinal manipulative therapy and safer sedation agents.

Limitations of evidence: The brief notes that evidence for spinal MUA and for serial/multi-joint MUA in chronic pain is very limited, with no randomized controlled trials identified and insufficient evidence to determine effects on health outcomes.

Definition — Manipulation Under Anesthesia (MUA): A series of mobilization, stretching, and traction procedures performed while the individual is sedated (usually with general anesthesia or moderate sedation).