Manipulation Under Anesthesia - UHCprovider.com

Manipulation Under Anesthesia Page 1 of 11 UnitedHealthcare Commercial Medical Policy Effective 04/01/2021 Proprietary Information of UnitedHealthcare. Copyright 2021 United HealthCare Services, Inc. UnitedHealthcare Commercial Medica l Policy Manipulation Under Anesthesia Policy Number: 2021T0515T Effective Date: April 1, 2021 Instructions for Use Table of Contents Page Coverage Rationale .. 1 Definitions .. 1 Applicable Codes .. 2 Description of Services .. 5 Clinical Evidence .. 5 Food and Drug Administration .. 9 References .. 9 Policy History/Revision Information .. 11 Instructions for Use .. 11 Coverage Rationale Manipulation Under Anesthesia (MUA) is proven and medically necessary for: Knee joint for Arthrofibrosis following total knee arthroplasty, knee surgery, or fracture Shoulder joint for adhesive capsulitis (frozen shoulder) MUA is unproven and not medically necessary for all other conditions (whether for single or serial manipulations) including but not limited to the following, due to insufficient evidence of efficacy: Ankle Finger Hip joint or adhesive capsulitis of the hip Knee joint - any condition other than for Arthrofibrosis following total knee arthroplasty, knee surgery, or fracture Pelvis Shoulder - any condition other than adhesive capsulitis (frozen shoulder) Spine Temporomandibular joint (TMJ) Toe Wrist This policy does not apply to the following: Manipulation of the finger on the day following the injection of coll

Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded) 25259 . Manipulation, wrist, under anesthesia : 26340 . Manipulation, finger joint, under anesthesia, each joint : 27198 . Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium,

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  Under, Anesthesia, Dislocation, Manipulation, Manipulation under anesthesia

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