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Manipulation Under Anesthesiaco MEDICAL POLICY MANIPULATION UNDER ANESTHESIACO Policy Number: 2014T0515I Effective Date: May 1, 2014 Table of Contents Page Related Policies: None BENEFIT CONSIDERATIONS………………………… 1 COVERAGE RATIONALE……………………………… 2 APPLICABLE CODES………………………………….. 2 DESCRIPTION OF SERVICES................................. 7 CLINICAL EVIDENCE………………………………….. 8 U.S. FOOD AND DRUG ADMINISTRATION………… 15 CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS)………………………………………. 15 REFERENCES………………………………………….. 15 POLICY HISTORY/REVISION INFORMATION…….. 17 Policy History Revision Information INSTRUCTIONS FOR USE This Medical Policy provides assistance in interpreting UnitedHealthcare benefit plans. When deciding coverage, the enrollee specific document must be referenced. The terms of an enrollee's document (e.g., Certificate of Coverage (COC) or Summary Plan Description (SPD) and Medicaid State Contracts) may differ greatly from the standard benefit plans upon which this Medical Policy is based. In the event of a conflict, the enrollee's specific benefit document supersedes this Medical Policy. All reviewers must first identify enrollee eligibility, any federal or state regulatory requirements and the enrollee specific plan benefit coverage prior to use of this Medical Policy. Other Policies and Coverage Determination Guidelines may apply. UnitedHealthcare reserves the right, in its sole discretion, to modify its Policies and Guidelines as necessary. This Medical Policy is provided for informational purposes. It does not constitute medical advice. UnitedHealthcare may also use tools developed by third parties, such as the MCG™ Care Guidelines, to assist us in administering health benefits. The MCG™ Care Guidelines are intended to be used in connection with the independent professional medical judgment of a qualified health care provider and do not constitute the practice of medicine or medical advice. BENEFIT CONSIDERATIONS Essential Health Benefits for Individual and Small Group: For plan years beginning on or after January 1, 2014, the Affordable Care Act of 2010 (ACA) requires fully insured non-grandfathered individual and small group plans (inside and outside of Exchanges) to provide coverage for ten categories of Essential Health Benefits (“EHBs”). Large group plans (both self-funded and fully insured), and small group ASO plans, are not subject to the requirement to offer coverage for EHBs. However, if such plans choose to provide coverage for benefits which are deemed EHBs (such as maternity benefits), the ACA requires all dollar limits on those benefits to be removed on all Grandfathered and Non-Grandfathered plans. The determination of which benefits constitute EHBs is made on a state by state basis. As such, when using this guideline, it is important to refer to the enrollee’s specific plan document to determine benefit coverage. Manipulation Under Anesthesia: Medical Policy (Effective 05/01/2014) 1 Proprietary Information of UnitedHealthcare. Copyright 2014 United HealthCare Services, Inc. COVERAGE RATIONALE Manipulation under anesthesia (MUA) is proven for: • Elbow joint for arthrofibrosis following elbow surgery or fracture • Knee joint for arthrofibrosis following total knee arthroplasty, knee surgery, or fracture • Pelvis for acute traumatic fracture or dislocation • Shoulder joint for adhesive capsulitis (e.g. frozen shoulder) Manipulation under anesthesia is unproven for: • Ankle • Finger* • Hip joint or adhesive capsulitis of the hip • Knee joint for any condition other than for arthrofibrosis following total knee arthroplasty, knee surgery, or fracture • Pelvis for diastasis or subluxation • Shoulder for any condition other than adhesive capsulitis (frozen shoulder) • Spine • Temporomandibular joint (TMJ) • Toe • Wrist Published studies which are available are of relatively small sample size, short-term outcomes and lack of randomization or a control group. * This policy does not apply to manipulation of the finger on the day following the injection of collagenase clostridium histolyticum (Xiaflex®) to treat Dupuytren’s contracture. Manipulation under anesthesia is unproven for serial manipulations for any body part or multiple body joints for the management of acute or chronic pain conditions. There is a lack of peer-reviewed published evidence supporting the need for multiple, repeat sessions of MUA for multiple body joints. APPLICABLE CODES The Current Procedural Terminology (CPT®) codes and Healthcare Common Procedure Coding System (HCPCS) codes listed in this policy are for reference purposes only. Listing of a service code in this policy does not imply that the service described by this code is a covered or non- covered health service. Coverage is determined by the enrollee specific benefit document and applicable laws that may require coverage for a specific service. The inclusion of a code does not imply any right to reimbursement or guarantee claims payment. Other policies and coverage determination guidelines may apply. This list of codes may not be all inclusive. CPT® Code Description Manipulation of temporomandibular joint(s) (TMJ), therapeutic, 21073 requiring an anesthesia service (i.e., general or monitored anesthesia care) 22505 Manipulation of spine requiring anesthesia, any region Manipulation under anesthesia, shoulder joint, including application of 23700 fixation apparatus (dislocation excluded) 24300 Manipulation, elbow, under anesthesia 25259 Manipulation, wrist, under anesthesia 26340 Manipulation, finger joint, under anesthesia, each joint Closed treatment of pelvic ring fracture, dislocation, diastasis or 27194 subluxation; with manipulation, requiring more than local anesthesia Manipulation Under Anesthesia: Medical Policy (Effective 05/01/2014) 2 Proprietary Information of UnitedHealthcare. Copyright 2014 United HealthCare Services, Inc. CPT® Code Description 27275 Manipulation, hip joint, requiring general anesthesia Manipulation of knee joint under general anesthesia (includes 27570 application of traction or other fixation devices) Manipulation of ankle under general anesthesia (includes application 27860 of traction or other fixation apparatus) CPT® is a registered trademark of the American Medical Association. ICD-9 Code (Proven) Description 718.51 Ankylosis of joint of shoulder region 718.52 Ankylosis of upper arm joint 718.56 Ankylosis of lower leg joint 726.0 Adhesive capsulitis of shoulder 728.6 Contracture of palmar fascia Closed fracture of sacrum and coccyx without mention of spinal cord 805.6 injury Closed fracture of sacrum and coccyx with complete cauda equina 806.61 lesion 806.62 Closed fracture of sacrum and coccyx with other cauda equina injury 808.0 Closed fracture of acetabulum 808.2 Closed fracture of pubis 808.41 Closed fracture of ilium 808.42 Closed fracture of ischium 808.43 Multiple closed pelvic fractures with disruption of pelvic circle 808.44 Multiple closed pelvic fractures without disruption of pelvic circle 808.49 Closed fracture of other specified part of pelvis 839.41 Closed dislocation, coccyx 839.42 Closed dislocation, sacrum ICD-10 Codes (Preview Draft) In preparation for the transition from ICD-9 to ICD-10 medical coding on October 1, 2015*, a sample listing of the ICD-10 CM and/or ICD-10 PCS codes associated with this policy has been provided below for your reference. This list of codes may not be all inclusive and will be updated to reflect any applicable revisions to the ICD-10 code set and/or clinical guidelines outlined in this policy. *The effective date for ICD-10 code set implementation is subject to change. ICD-10 Diagnosis Code Description (Effective 10/01/15) M24.611 Ankylosis, right shoulder M24.612 Ankylosis, left shoulder M24.619 Ankylosis, unspecified shoulder M24.621 Ankylosis, right elbow M24.622 Ankylosis, left elbow M24.629 Ankylosis, unspecified elbow M24.661 Ankylosis, right knee M24.662 Ankylosis, left knee M24.669 Ankylosis, unspecified knee M72.0 Palmar fascial fibromatosis[Dupuytren] M75.00 Adhesive capsulitis of unspecified shoulder M75.01 Adhesive capsulitis of right shoulder M75.02 Adhesive capsulitis of left shoulder M99.14 Subluxation complex (vertebral) of sacral region S32.10XA Unspecified fracture of sacrum, initial encounter for closed fracture Manipulation Under Anesthesia: Medical Policy (Effective 05/01/2014) 3 Proprietary Information of UnitedHealthcare. Copyright 2014 United HealthCare Services, Inc. ICD-10 Diagnosis Code Description (Effective 10/01/15) Nondisplaced Zone I fracture of sacrum, initial encounter for closed S32.110A fracture Minimally displaced Zone I fracture of sacrum, initial encounter for S32.111A closed fracture Severely displaced Zone I fracture of sacrum, initial encounter for S32.112A closed fracture Unspecified Zone I fracture of sacrum, initial encounter for closed S32.119A fracture Nondisplaced Zone II fracture of sacrum, initial encounter for closed S32.120A fracture Minimally displaced Zone II fracture of sacrum, initial encounter for S32.121A closed fracture Severely displaced Zone II fracture of sacrum, initial encounter for S32.122A closed fracture Unspecified Zone II fracture of sacrum, initial encounter for closed S32.129A fracture Nondisplaced Zone III fracture of sacrum, initial encounter for closed S32.130A fracture Minimally displaced Zone III fracture of sacrum, initial encounter for S32.131A closed fracture Severely displaced Zone III fracture of sacrum, initial encounter for S32.132A closed fracture Unspecified Zone III fracture of sacrum, initial encounter for closed S32.139A fracture S32.14XA
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