Vertebral Axial Decompression

This policy addresses vertebral axial decompression (mechanized spinal distraction/traction therapy, e.g., VAX‑D) for adults with chronic low back pain, including lumbar disc herniation, degenerative disc disease, and lumbar radiculopathy. However, the therapy is considered experimental/investigational and not covered under this policy—coverage decisions depend on the member’s benefit plan/SPD and prior failure of standard conservative therapies; when used it should be billed with HCPCS S9090 (not CPT 97012) and typically involves ~10–15 sessions with ≥6 months follow‑up.

"Relief of low back pain associated with herniated lumbar discs"

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