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Date Printed: June 26, 2017: 01:27 AM

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Subject: Manipulation under Anesthesia

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This medical coverage guideline is not an authorization, certification, explanation of benefits, or a guarantee of payment, nor does it substitute for or constitute medical advice. All medical decisions are solely the responsibility of the patient and physician. Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. This medical coverage guideline applies to all lines of business unless otherwise noted in the program exceptions section.

 

DESCRIPTION

Manipulation under anesthesia, or MUA, is used to treat joints that are not properly aligned. This treatment method may improve motion and reduce pain. Normally, the muscles around a joint in this condition will try to prevent the joint from moving due to pain. To avoid this, in this form of treatment you are first anesthetized, relaxing your muscles completely. This allows the joint to move more freely. Your doctor will then manipulate the effected joint to realign it and improve its range of motion.

Visit the Clinical View of this guideline for more information.

COVERAGE

 

Note: For all medical decisions about this service, Florida Blue uses the Position Statement in the Clinical View of this medical coverage guideline. To make the best decision for your health needs, talk to your doctor. The services covered vary from health plan to health plan. Refer to your health plan contract for complete information about your coverage.

 

Manipulation under anesthesia services may be covered if certain requirements are met for:

• Adhesive capsulitis (frozen shoulder)

• Arthrofibrosis after total knee replacement or other knee surgeries

• Arthrofibrosis after joint surgery that does not respond to other conservative therapy

• Joint dislocations confirmed by medical imaging

Manipulation for other joint disorders, including the spine or hip/pelvis area is considered experimental or investigational. Clinical evidence is not sufficient to support this treatment.

Visit the Clinical View of this guideline for specific coverage information.

PROGRAM EXCEPTIONS

• Federal Employee Program (FEP): Certain exceptions apply.

• State Account Organization (SAO): Certain exceptions apply.

• Medicare Advantage products: Certain exceptions apply.

Visit the Clinical View of this guideline for more coverage information.

Refer to your health plan contract for complete information about your coverage.

Date Printed: June 26, 2017: 01:27 AM