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Manipulation Under Anesthesia (MUA)

Section: Surgery
Effective Date: July 01, 2018
Revised Date: August 08, 2019
Last Reviewed: July 16, 2019

Description

Manipulation under anesthesia (MUA) consists of a series of mobilization, stretching, and traction procedures performed while the patient receives anesthesia (usually general anesthesia or moderate sedation).

Criteria

MUA of the Knee

MUA of the knee may be considered medically necessary when ALL of the following are met;

  • To treat significant arthrofibrosis of the knee resulting from trauma or knee surgery; and
  • After an adequate trial of conservative measures (physical therapy and joint injections) have failed to restore range of motion and relieve pain; and
  • Is limited to a single treatment session.

MUA of the knee is considered not medically necessary for the following indications:

  • When above criteria have not been met
  • For serial manipulations.

When MUA is not medically necessary, all associated services, such as anesthesia and facility expenses will also be considered not medically necessary.

 

Procedure Codes

27570

MUA of the Shoulder

MUA of the shoulder may be considered medically necessary when ALL of the following are met:

  • To treat capsulitis of the shoulder; and
  • After an adequate trial of conservative measures (physical therapy and joint injections) have failed to restore range of motion and relieve pain; and
  • Is limited to a single treatment session.

MUA of the shoulder is considered not medically necessary for the following indications:

  • When above criteria have not been met
  • For serial manipulations.

When MUA is not medically necessary, all associated services, such as anesthesia and facility expenses will also be considered not medically necessary.

 

Procedure Codes

23700

MUA of the Ankle, Elbow, Finger, Hip, Pelvic Ring, Spine, and Wrist

MUA of the ankle, elbow, finger, hip, pelvic ring, spine, and wrist is considered not medically necessary.

 

Procedure Codes

22505 24300 25259 26340 27198 27275 27860

Documentation Requirements

The medical record should include the following documentation:

  • Failure of condition to respond to conservative therapy, i.e., physical therapy and joint injections;
  • Evidence of decreased range of motion; and,
  • Length of time that the patient has been symptomatic.

Diagnosis Codes

 

Covered diagnosis codes for 27570

M24.661 M24.662 M24.669 Z96.651 Z96.652 Z96.653 Z96.659

 

Covered diagnosis codes for 23700

M75.00 M75.01 M75.02

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