SURG.00008 Mechanized Spinal Distraction Therapy

This policy addresses mechanized spinal distraction therapy using computerized spinal decompression tables (e.g., VAX-D, Decompression Reduction Stabilization DRS, Accu-Spina/IDD Therapy). Anthem deems this therapy investigational and not medically necessary; it is not covered for low back pain or any other condition (no covered indications). Non-coverage applies to all devices in this category and services billed under HCPCS/CPT codes 97039 and S9090.

"Use of mechanized spinal distraction therapy, including, but not limited to, the VAX-D®Therapeutic Table, the Decompression Reduction Stabilization DRS®System, and Accu-Spina System™IDD Therapy..."

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