It is recommended that an assistant who is certified in the procedure be present to assist in the performance of MUA. It is essential that the assistant be knowledgeable in the biomechanics and pathomechanics of the condition being treated towards an effort to assist proper positioning before and during the manipulative procedures performed by the primary physician. Many manipulative procedures under anesthesia are performed in tandem by the manipulator and assistant. Most facilities require a MUA certified assistant be present for spinal MUA cases.
Because of the extensive clinical data on the efficacy of MUA, manipulation under anesthesia has been endorsed and included in the American Medical Association’s CPT Code publication since 1971. The CPT code for spinal MUA is 22505. There are other CPT codes for appendicular manipulation under anesthesia.
Medicare Medical Policy Bulletin (http://www.hgsa.com/professionals/policy/s111aj.html)
Revision Date: 02/01/2002 (S-111A) Compliance with Transmittal # AB-00-126 (CR 1415)
“Manipulation under anesthesia (MUA) is designed to stretch or tear the particular adhesions that form around the articular facets of the spine or around herniated or bulging discs. These particular adhesions tend to lock the spine in a state of fixation, preventing normal movement and causing pain. The paraspinal muscles cause a splinting or guarding at the adhesion site, which makes traditional manipulation less effective. By placing the patient in a “twilight” anesthesia, complete relaxation is achieved, allowing the provider to directly influence particular adhesions by diminishing the postural musculature. Since the adhesions are neurovascular, there is no bleeding or pain following the manipulation.
Indications and Limitations of Coverage and/or Medical Necessity:
Because of refinements in manipulative medicine techniques and improvements in physical therapy modalities, this procedure should only be performed on select patients who have failed to respond to conservative therapy.”