Description

Manipulation under anesthesia (MUA) is a noninvasive treatment technique utilized by a Doctor of Chiropractic (DC), Doctor of Medicine (MD) and/or Doctor of Osteopathic Medicine (DO) to treat acute and chronic conditions, including muscular or spinal pain. MUA may utilize general anesthesia, mild sedation or following the injection of anesthetic solution(s) into spinal tissue.

Under anesthesia, spastic muscles are believed to relax and pain sensations diminish, which theoretically permit spine and joint manipulation through a full range of motion. The manipulation is thought to stretch or remove fibrous adhesions, stretch overburdened support tissues and help relax spastic muscles.

Page: 1 of 5

Manipulation Under Anesthesia

Effective Date: 07/27/2023

Revision Date: 07/27/2023

Review Date: 07/27/2023

Policy Number: HUM-0392-018

Page: 2 of 5

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Coverage Determination

Humana members may NOT be eligible under the Plan for spinal manipulation under anesthesia OR for manipulation of a joint* under anesthesia in the absence of adhesive capsulitis (eg, frozen shoulder), completely dislocated joint, arthrofibrosis (fibrosis of a joint) that may occur following total joint replacement and/or fractures. These are considered experimental/ investigational as they are not identified as widely used and generally accepted for the proposed uses as reported in nationally recognized peer-reviewed medical literature published in the English language.

*Manipulation under anesthesia for adhesive capsulitis (eg, frozen shoulder), completely dislocated joint, arthrofibrosis (fibrosis of a joint) that may occur following total joint replacement and/or fractures is generally considered medically necessary and is not subject to the criteria within this medical coverage policy.

Background

Additional information about musculoskeletal conditions, including back and neck pain may be found from the following websites:

• American Academy of Orthopaedic Surgeons
• American College of Rheumatology
• National Library of Medicine

Medical Alternatives

Alternatives to MUA include, but may not be limited to, the following:

• Pain management program
• Physical or occupational therapy (please refer to Physical Therapy and Occupational Therapy Medical Coverage Policy)
• Prescription drug therapy
• Standard chiropractic manipulation (please refer to Chiropractic Care Medical Coverage Policy)

Page: 3 of 5

Humana's documents are updated regularly online. When printed, the version of this document becomes uncontrolled. Do not rely on printed copies for the most up-to-date version. Refer to Medical and Pharmacy Coverage Policies to verify that this is the current version before utilizing.

Physician consultation is advised to make an informed decision based on an individual’s health needs.

Any CPT, HCPCS or ICD codes listed on this medical coverage policy are for informational purposes only. Do not rely on the accuracy and inclusion of specific codes. Inclusion of a code does not guarantee coverage and or reimbursement for a service or procedure.