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    OpenPayerPolicy UpdatesOrthopedics/Musculoskeletalevicore MUA Coverage Policy Update | OpenPayer
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    CurrentevicorePolicy CMM-310

    Manipulation of the Spine Under Anesthesia (MUA)

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    Defines clinical coverage criteria for manipulation of the spine under anesthesia (MUA) for Cigna-administered health benefit plans and explains when MUA is considered medically necessary or not medically necessary.

    Policy Summary
    Payerevicore
    PolicyManipulation of the Spine Under Anesthesia (MUA)
    Policy CodePolicy CMM-310
    Change TypeNo material change
    Effective DateMar 7, 2026
    Next Review Date
    Key ActionDocument emergent closed treatment of traumatically induced vertebral fracture or dislocation and participation in an active rehabilitation/home exercise program when applicable.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    2required criteria
    2not medically necessary
    1CPT codes listed
    2026-03-07effective

    Coverage Criteria for Manipulation of the Spine Under Anesthesia (MUA)

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    Medically Necessary

    Covered when BOTH of the following are met:

    MUA medical necessity criteria

    • Criterion 1: Performed in an emergent situation as a closed treatment of traumatically induced vertebral fracture or dislocation to mitigate the potential for neurological compromise when a qualified physician has considered the decision for an open reduction.
    • Criterion 2: Performed in conjunction with an active rehabilitation/home exercise program.

    Covered when BOTH of the following are met: 1) the procedure is performed in an emergent setting as a closed treatment of a traumatically induced vertebral fracture or dislocation to mitigate potential for neurological compromise when a qualified physician has considered the need for open reduction; AND 2) the procedure is performed in conjunction with an active rehabilitation/home exercise program.

    Manipulation of the spine under anesthesia (MUA) performed in the absence of a traumatically induced vertebral fracture or dislocation is considered not medically necessary. Likewise, MUA performed in isolation without the individual participating in an active rehabilitation/home exercise program is considered not medically necessary and may be denied.

    Coding

    Listed CPT CodesCPT
    22505Manipulation of spine requiring anesthesia, any region.

    Provider Actions, Documentation & Prior Authorization

    Prior Authorization

    Prior authorization depends on the member's plan; CPT 22505 listing ≠ coverage

    Prior authorization requirements depend on the applicable health plan; inclusion of CPT code 22505 in the code table does not itself imply EviCore review or guarantee coverage—refer to the member's health plan for management details.

    • CPT code listed: 22505 — Manipulation of spine requiring anesthesia, any region.
    • Inclusion of a code in the table does not imply the code is under management or requires prior authorization; check the member's Certificate of Coverage or Evidence of Coverage.
    Step Therapy

    No step therapy specified

    There are no step therapy requirements specified in this policy for Manipulation of the Spine Under Anesthesia (MUA).

    Documentation Required

    Required clinical documentation for MUA

    Documentation must demonstrate emergent closed treatment of a traumatically induced vertebral fracture or dislocation with consideration of open reduction, and when MUA is performed, documentation must show participation in an active rehabilitation/home exercise program.

    • Evidence that MUA was performed in an emergent situation as closed treatment of a traumatically induced vertebral fracture or dislocation to mitigate potential for neurological compromise and that a qualified physician considered open reduction (chunk 9).
    • Documentation of participation in an active rehabilitation/home exercise program when MUA is performed (chunks 9 and 13).
    Denial Risk

    Denial risk if indication is non‑traumatic

    MUA performed in the absence of a traumatically induced vertebral fracture or dislocation is considered not medically necessary and may be denied.

    • Policy states MUA without traumatically induced vertebral fracture or dislocation is considered not medically necessary due to lack of evidence of long-term efficacy and safety.
    Denial Risk

    Denial risk if no concurrent rehabilitation/home exercise program

    MUA performed in isolation—without the individual participating in an active rehabilitation or home exercise program—is considered not medically necessary and may be denied.

    • Policy requires MUA to be performed in conjunction with an active rehabilitation/home exercise program; absence of such concurrent rehabilitation is grounds for noncoverage.

    Background

    Manipulation of the spine under anesthesia (MUA) refers to spinal manipulation performed while the individual is sedated or under general anesthesia. This policy frames MUA primarily for emergent closed treatment of traumatically induced vertebral fracture or dislocation, and otherwise requires participation in an active rehabilitation/home exercise program for coverage consideration.

    Definitions

    Manipulation of the spine under anesthesia (MUA) — definition and key context
    DefinitionManipulation of the spine under anesthesia (MUA): spinal manipulation performed when the individual is sedated or under general anesthesia.
    Clinical contextFramed primarily for emergent closed treatment of traumatically induced vertebral fracture or dislocation to mitigate potential for neurological compromise.
    Requirement for medical necessityCovered only when performed in an emergent situation as a closed treatment of traumatically induced vertebral fracture or dislocation and when a qualified physician has considered open reduction.
    Concurrent care expectationWhen performed, MUA must be done in conjunction with an active rehabilitation/home exercise program.
    Policy Summary
    Payerevicore
    PolicyManipulation of the Spine Under Anesthesia (MUA)
    Policy CodePolicy CMM-310
    Change TypeNo material change
    Effective DateMar 7, 2026
    Next Review Date
    Key ActionDocument emergent closed treatment of traumatically induced vertebral fracture or dislocation and participation in an active rehabilitation/home exercise program when applicable.
    SourceLink
    On This Page
    Coverage Criteria for Manipulation of the Spine Under Anesthesia (MUA)CodingProvider Actions, Documentation & Prior AuthorizationBackgroundDefinitions