Lumbar Traction Devices

Aetna covers supervised mechanical lumbar traction provided by physicians or physical therapists as part of conservative treatment for low back pain (typically delivered with other therapies and limited to about four sessions per week), but does not list any specific device-based indications as medically necessary. Aetna considers autotraction devices (e.g., Anatomotor, Arthrotonic stabilizer, Quantum 400, Spinalator), home pneumatic lumbar traction devices (e.g., Orthotrac, Saunders HomeTrac/STx, DDS 500), axial spinal unloading/decompression systems (e.g., LTX 3000, Triton DTS, Z‑Grav), and lumbar lordotic curve‑controlled devices (e.g., Kinetrac‑9900) experimental/investigational and not covered.

"HCPCS/CPT/ICD-10 codes NOT COVERED for indications listed in the CPB: E0830 (Ambulatory traction device, all types, each) is listed as NOT covered for CPB indications."