Payer PolicyActive
CMM-310: Manipulation of the Spine Under Anesthesia
EVICORE-CMM-310-MANIPSPINEANESTH_FINAL
EviCore by Evernorth
Effective: August 1, 2024
Updated: January 13, 2026
created · Dec 5, 2025
Policy Summary
MUA of the spine is covered only as an emergent closed treatment for traumatically induced vertebral fracture or dislocation (excluded for non‑traumatic/elective indications or when performed in isolation without rehab). Key requirements: a qualified physician must have considered open reduction beforehand, the procedure must be done with an active rehabilitation/home exercise program, and documentation must include emergent/operative notes, imaging, physician rationale, rehab plan/participation, and anesthesia/operative records.
Coverage Criteria Preview
Key requirements from the full policy
"The use of manipulation of the spine under anesthesia (MUA) (i."
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