LCD/NCD Portal

L30563

 

MANIPULATION UNDER ANESTHESIA (MUA)

 

 

01/25/2010

 

 

Indications and Limitations of Coverage and/or Medical Necessity

 

FCSO Medicare considers the following indications/conditions medically necessary for MUA:

• MUA should only be performed on select patients who have failed to respond to conservative therapy.

• Adhesive capsulitis (i.e., frozen shoulder) when there is failure of conservative medical management including

o medications

o with or

o without articular injections,

o home exercise programs, and

o physical therapy; or

• Elbow joint for arthrofibrosis following

o elbow surgery or

o fracture, or

• Arthrofibrosis of the knee following trauma or knee surgery (e.g., total knee replacement, anterior

o cruciate ligament repair) with

o less than 90 degrees range of motion

o 4 weeks to 6 months following surgery.

 

 

Limitations

• MUA provided for the above indications/conditions consists of a SINGLE treatment session involving an isolated joint. Multiple joint MUAs on the same date of service should be rare.

o Repeat procedures during the global period would not be expected. (See Utilization Guidelines)

• Only M.D. /D.O. physicians who have training and competency in manipulation should perform this procedure.

o This procedure must be performed in an outpatient surgery facility or inpatient hospital setting.

o An office setting would not be appropriate for performing MUA.

• MUA performed by a Chiropractor is not a Medicare covered chiropractic service.

o Medicare coverage for Doctors of Chiropractic “extends only to treatment by means of manual manipulation of the spine to correct a subluxation demonstrated by X-ray, provided such treatment is legal in the state where performed.

o All other services furnished or ordered by chiropractors are not covered,” see CMS Pub. 100-01, chapter 5, section 70.6, and the FCSO Part B LCD for Chiropractic Services.

• CPT code 27194 (Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; with manipulation, requiring more than local anesthesia) is not covered if performed with the MUA services addressed in this LCD.

 

 

Coding Information

 

Bill Type Codes

• Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.

• Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type.

• Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

 

12x Hospital Inpatient (Medicare Part B only)

13x Hospital Outpatient

85x Critical Access Hospital

Revenue Codes

• Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service.

• In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination.

• Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

 

0360 Operating Room Services - General Classification

 

 

CPT/HCPCS Codes

 

23700 MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDING APPLICATION OF FIXATION APPARATUS (DISLOCATION EXCLUDED)

24300 MANIPULATION, ELBOW, UNDER ANESTHESIA

27570 MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA (INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION DEVICES)

 

The following CPT code is not covered. There is insufficient clinical evidence to support spinal MUA and, therefore, it is not considered reasonable and necessary:

22505 MANIPULATION OF SPINE REQUIRING ANESTHESIA, ANY REGION

 

 

ICD-9 Codes that Support Medical Necessity

 

For procedure code 23700:

718.51 ANKYLOSIS OF JOINT OF SHOULDER REGION

718.52 ANKYLOSIS OF UPPER ARM JOINT

718.58 ANKYLOSIS OF JOINT OF OTHER SPECIFIED SITES

726.0 ADHESIVE CAPSULITIS OF SHOULDER

726.10 DISORDERS OF BURSAE AND TENDONS IN SHOULDER REGION UNSPECIFIED

726.11 CALCIFYING TENDINITIS OF SHOULDER

 

For procedure code 24300:

718.52 ANKYLOSIS OF UPPER ARM JOINT

718.58 ANKYLOSIS OF JOINT OF OTHER SPECIFIED SITES

 

For procedure code 27570:

 

718.56 ANKYLOSIS OF LOWER LEG JOINT

718.58 ANKYLOSIS OF JOINT OF OTHER SPECIFIED SITES

 

 

Documentation Requirements

• Medical record documentation maintained by the treating provider must substantiate the medical necessity of the services being billed.

o In addition, documentation that the service was performed must be included in the patient’s medical record.

o This information is normally found in the history and physical, office/progress notes, hospital notes, and/or procedure report.

• The medical record must clearly show that the criteria listed under the “Indications and Limitations of Coverage and/or Medical Necessity” section have been met, as well as the appropriate diagnosis and response to treatment.

 

 

Utilization Guidelines

• When indications for the shoulder, elbow, or knee are met, only a SINGLE treatment session for an isolated joint for one date of service should be billed.

• A repeat procedure on the same joint or multiple joints outside the global period should be rare and may be subject to medical review. Staged (planned or anticipated) procedures on multiple joints during the global period or consecutive days/weeks are not considered medically necessary and will be denied.

• MUA for single joints during the global period should be rare and may be subject to pre-payment medical review.

 

 

Treatment Logic

• Manipulation under anesthesia (MUA) is a non-invasive procedure which combines manual manipulation of a joint or the spine with a general anesthetic.

• Patients who are unable to tolerate manual procedures due to pain, spasm, muscle contractures, or guarding may benefit from the use of general anesthesia prior to manipulation.

• Because the patient’s protective reflex mechanism is absent under anesthesia, manipulation using a combination of specific short lever manipulations, passive stretches, and specific articular and postural kinesthetic maneuvers in order to break up fibrous adhesions and scar tissue around the joint and surrounding tissue is made less difficult.

• MUA should only be performed on select patients who have failed to respond to conservative therapy.

 

 

Sources of Information and Basis for Decision

 

Aetna Clinical Policy Bulletin: Manipulation under anesthesia. Number 0204, Last review 2009.

 

American Medical Association. CPT Assistant Archives 1990 – 2007.

 

American Medical Association. CPT Changes, An Insider’s View. 2002, 2003, 2005.

 

American Medical Association. Current Procedural Terminology: CPT 2009.

 

Blue Cross and Blue Shield of Florida: Manipulation under anesthesia. 02-20000-34, Revised 2009.

 

Cigna Medical Coverage Policy: Manipulation under anesthesia (MUA). # 0276, effective date 10/15/2008.

 

Dagenais, S., Mayer, J., Wooley, J., and Haldeman, S. (2008). Evidence-informed management of chronic low back pain with medicine-assisted manipulation. The Spine Journal 8 142-149.

 

FCSO LCD 30572, Manipulation Under Anesthesia (MUA), 01/25/2010, The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

Francis, R. (2005). Manipulation under anesthesia (MUA). International MUA Academy of Physicians. Retrieved July 28, 2009 from http://www.muaphysicians.com

 

International MUA Academy of Physicians. An overview of manipulation under anesthesia (MUA) 2005.

 

Keating, M., Ritter, M., Harty, L., Haas, G., Meding, J., Faris, P., et al. (2007). Manipulation after total knee arthroplasty. The Journal of Bone and Joint Surgery 89:282-286.

 

Magit, D., Wolff, A., Sutton, K., & Medvecky, M. (2007). Arthrofibrosis of the knee. Journal of the American Academy of Orthopaedic Surgeons 15; 682-694.

 

National Academy of Manipulation Under Anesthesia Physicians. (2002).

 

Quraishi, N., Johnston, P., Bayer, J., Crowe, M., and Chakrabarti, A. (2007). Thawing the frozen shoulder – A randomized trial comparing manipulation under anesthesia with hydrodilatation. The Journal of Bone & Joint Surgery 89-B: 1197-1200.

 

UnitedHealthcare: Manipulation under anesthesia. Policy #: ANESTHESIA 004.2 T2. Effective date June 1, 2009.

 

Your orthopaedic connection (2007). Frozen shoulder. American Academy of Orthopaedic Surgeons. Retrieved August 17, 2009 , from http://orthoinfo.aaos.org/topic.cfm?topic=A00071

 

01/25/2010

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

 

CMS LCD MANIPULATION UNDER ANESTHESIA (MUA)