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MUA has been used in various forms since the 1930s. Complications from general anesthesia and forceful long-lever, high-amplitude nonspecific manipulation procedures resulted in decreased use of the procedure in favor of other therapies. MUA was modified and revived in the 1990s. This revival is attributed to increased interest in spinal manipulative therapy and the advent of safer, shorter-acting anesthesia agents used for conscious sedation.

MUA is described as follows: after sedation is achieved, a series of mobilization, stretching, and traction procedures to the spine and lower extremities is performed and may include passive stretching of the gluteal and hamstring muscles with straight leg raise, hip capsule stretching and mobilization, lumbosacral traction, and stretching of the lateral abdominal and paraspinal muscles. After the stretching and traction procedures, spinal manipulative therapy (SMT) is delivered with high-velocity, short-amplitude thrust applied to a spinous process by hand while the upper torso and lower extremities are stabilized. SMT may also be applied to the thoracolumbar or cervical area if considered necessary to address the low back pain. The MUA takes 15–20 minutes, and after recovery from anesthesia the patient is discharged with instructions to remain active and use heat or ice for short-term analgesic control. Some practitioners recommend performing the procedure on 3 consecutive days for best results. Care after MUA may include 4–8 weeks of active rehabilitation with manual therapy including SMT and other modalities.

Manipulation is intended to break up fibrous and scar tissue to relieve pain and improve range of motion. Anesthesia or sedation is used to reduce pain, spasm, and reflex muscle guarding that may interfere with the delivery of therapies and to allow the therapist to break up joint and soft-tissue adhesions with less force than would be required to overcome patient resistance or apprehension. MUA is generally performed with an anesthesiologist in attendance. Manipulation has also been performed after injection of local anesthetic into lumbar zygapophyseal and/or sacroiliac joints under fluoroscopic guidance (MUJA) and after epidural injection of corticosteroid and local anesthetic (MUESI). 

Spinal manipulation and manipulation of other joints under anesthesia involving serial treatment sessions is considered investigational.

Manipulation under anesthesia involving multiple body joints is considered investigational for treatment of chronic pain.

Note: This policy statement does not address manipulation under anesthesia for fractures, completely dislocated joints, adhesive capsulitis (e.g., frozen shoulder), and/or fibrosis of a joint that may occur following total joint replacement. 

None

Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

12/18/2003: Code Reference section updated

5/11/2009: Policy reviewed, no changes

06/22/2010: Policy was updated extensively. The title was changed from “Spinal Manipulation under Anesthesia” to “Manipulation under Anesthesia for Treatment of Chronic Spinal or Pelvic Pain.” Policy description was revised to address chronic spinal pain, chronic sacroiliac and pelvic pain. Policy statement was revised to indicate that spinal manipulation with the patient under anesthesia, spinal manipulation under joint anesthesia, and spinal manipulation after epidural anesthesia and corticosteroid injection are considered investigational for treatment of chronic spinal pain and chronic sacroiliac and pelvic pain. The Covered Codes table was deleted, CPT code 22505 was moved to the non-covered codes table, and CPT code 00640 was added to the non-covered codes table based on this investigational policy statement. Notes were also added to indicate that the policy statement does not address manipulation under anesthesia for fractures, completely dislocated joints, adhesive capsulitis (e.g., frozen shoulder), and/or fibrosis of a joint that may occur following total joint replacement.

12/30/2010:  Deleted "for Treatment of Chronic Spinal or Pelvic Pain” from the policy title.  Added two investigational policy statements:  1) Spinal manipulation and manipulation of other joints under anesthesia involving serial treatment sessions is considered investigational.  2)Manipulation under anesthesia involving multiple body joints is considered investigational for treatment of chronic pain.

12/01/2011: Policy reviewed; no changes.

12/13/2012: Policy reviewed; no changes.

Blue Cross Blue Shield Association policy # 8.01.40

These codes are considered investigational and not eligible for coverage for the conditions outlined in the policy statement section. This is not an all-inclusive list of non-covered procedure codes.

Non-Covered Codes