Anthem Blue Cross Connecticut SURG.00008 Mechanized Spinal Distraction Therapy Form
Procedure is not covered
This document addresses the use of mechanized spinal distraction therapy. There are many devices currently available that are used for this therapy, including, but not limited to the Vertebral Axial Decompression (VAX-D®) Therapeutic Table, the Decompression Reduction Stabilization DRS® System and the Accu-Spina System™ IDD Therapy.
Position Statement
Investigational and Not Medically Necessary:
Use of mechanized spinal distraction therapy, including, but not limited to, the VAX-D® Therapeutic Table, the Decompression Reduction Stabilization DRS® System, and Accu-Spina System™ IDD Therapy, is considered investigational and not medically necessary for the treatment of low back pain or any other condition.