Manipulation Under Anesthesia (MUA) of the Musculoskeletal System
DESCRIPTION
Manipulation under anesthesia (MUA) is a series of mobilization, stretching, and traction procedures performed while the individual is sedated (usually with general anesthesia or moderate sedation). 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 an accepted treatment for certain isolated joint conditions, such as arthrofibrosis of the knee and for temporomandibular joint syndrome. It is also used to reduce fractures (e.g., vertebral, long bones) and acute/traumatic dislocations. It is typically performed with surgical repair and other medically necessary procedures such as arthroscopy. When performed in this context, MUA is considered incidental to the base procedure.
Spinal manipulation under anesthesia has been explored in the treatment of acute and chronic back and neck pain where there has been limited success of prior attempts to manipulate the spine. Scientific evidence on spinal MUA, spinal manipulation with joint anesthesia, and spinal manipulation after epidural anesthesia and corticosteroid injection is very limited and insufficient to determine the effects on health outcomes.
Note: This policy does not apply to manipulation under anesthesia for adhesive capsulitis (i.e., frozen shoulder). Please refer to the MCG: Shoulder Arthroscopy ORG: S-1045 (ISC).
POLICY
Manipulation under anesthesia is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below).
Spinal manipulation under anesthesia (e.g. general anesthesia, joint anesthesia, epidural anesthesia with corticosteroid injections) as a treatment for conditions including, but not limited to chronic spinal pain (e.g. cranial, cervical, thoracic, and lumbar) and chronic sacroiliac and pelvic pain, is considered investigational.
Manipulation under anesthesia involving multiple joints and serial treatment sessions (greater than one treatment) is considered investigational.
MEDICAL APPROPRIATENESS
Manipulation under anesthesia is considered medically appropriate if ANY ONE of the following criteria are met:
Arthrofibrosis of the knee following total knee arthroplasty, knee surgery, or fracture
Temporomandibular joint disorder
Closed reduction of displaced fracture for joints in the wrist, elbow, hand, finger, ankle, and hip
Complete joint dislocation of the wrist, elbow, hand, finger, ankle, and hip
IMPORTANT REMINDERS
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g., statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits, or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the medical policy and a health plan or government program (e.g., TennCare), the express terms of the health plan or government program will govern.
SOURCES
American Association of Manipulation under Anesthesia Providers. (2014, February). Guidelines for the practice and performance of manipulation under anesthesia. Chiropractic & Manual Therapies, 22 (7), 1-7.
BlueCross BlueShield Association. Evidence Positioning System. (3:2023). Temporomandibular joint dysfunction. (2.01.21). Retrieved May 9, 2023 from www.bcbsaoca.com/eps/. (45 articles and/or guidelines reviewed)
BlueCross BlueShield Association. Evidence Positioning System. (5:2023). Manipulation under anesthesia. (8.01.40). Retrieved May 9, 2023 from www.bcbsaoca.com/eps/. (12 articles and/or guidelines reviewed)
Digiorgi, D. (2013). Spinal manipulation under anesthesia: a narrative review of the literature and commentary. Chiropractic and Manual Therapies, 21 (1), 14. (Level 2 evidence)
Li, Z., Lan, F., Shen, Y., An, S., Xu, N., Yin, C., et al. (2019). Prediction of the need for manipulation under anesthesia for flexion contracture after total knee arthroplasty in patients of advanced age. Journal of International Medical Research, 0 (0), 1-9. (Level 4 evidence)
Salomon, M., Pastore, C., Maselli, F., Di Bari, M., Pellegrino, R., & Brindisino, F. (2022). Manipulation under anesthesia versus non-surgical treatment for patients with frozen shoulder contracture syndrome: A systematic review. International Journal of Environmental Research and Public Health, 19 (15), 9715. (Level 2 evidence)
ORIGINAL EFFECTIVE DATE: 8/1/2002
MOST RECENT REVIEW DATE: 7/13/2023
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.