The version of this policy will become effective 05/18/2020.
The intent of this policy has not changed, although it has been updated to further define spinal manipulation and subluxation.
The following HCPCS code has been added to the policy: S8990.
The following ICD-10 diagnosis codes have been removed from the policy: M79.10, M79.11, M50.120, M50.820, M50.920, M50.220, M50.320, M99.62, M99.63, M99.72, M99.73, Q76.2, S13.100A, S13.100D, S13.100S, S13.101A, S13.101D, S13.101S, S13.110A, S13.110D, S13.110S, S13.111A, S13.111D, S13.111S, S13.120A, S13.120D, S13.120S, S13.121A, S13.121D, S13.121S, S13.130A, S13.130D, S13.130S, S13.131A, S13.131D, S13.131S, S13.140A, S13.140D, S13.140S, S13.141A,S13.141D, S13.141S, S13.150A, S13.150D, S13.150S, S13.151A, S13.151D, S13.151S, S13.160A, S13.160D, S13.160S, S13.161A, S13.161D, S13.161S, S13.170A, S13.170D, S13.170S, S13.171A, S13.171D, S13.171S, S13.180A, S13.180D, S13.180S, S13.181A, S13.181D,S13.181S, S14.2XXA, S14.2XXD, S14.2XXS, S14.3XXA, S14.3XXD, S14.3XXS, S23.0XXA, S23.0XXD, S23.0XXS, S23.100A, S23.100D, S23.100S, S23.101A, S23.101D, S23.101S, S23.110A, S23.110D, S23.110S, S23.111A, S23.111D, S23.111S, S23.120A, S23.120D, S23.120S, S23.121A, S23,121D, S23.121S, S23.122A,S23.122D, S23.122S, S23.123A, S23.123D, S23.123S, S23.130A, S23.130D,S23.130S, S23.131A, S23.131D, S23.131S, S23.132A, S23.132D, S23.132S, S23.133A, S23.133D, S23.133S, S23.140A, S23.140D, S23.140S, S23.141A, S23.141D, S23.141S, S23.142A, S23.142D, S23.142S, S23.143A, S23.143D, S23.143S, S23.150A, S23.150D,S23.150S, S23.151A, S23.151D, S23.151S, S23.152A, S23.152D, S23.152S, S23.153A, S23.153D, S23.153S, S23.160A, S23.160D, S23.160S, S23.161A, S23.161D, S23.161S, S23.162A, S23.162D, S23.162S, S23.163A, S23.163D, S23.163S, S23.170A, S23.170D, S23.170S, S23.171A, S23.171D, S23.171S, S24.2XXA, S24.2XXD, S24.2XXS, S33.0XXA, S33,0XXD, S33.0XXS, S33.100A, S33.100D, S33.100S, S33.101A, S33.101D, S33.101S, S33.110A, S33.110D, S33.110S, S33.111A, S33.111D, S33.111S, S33.120A, S33.120D, S33.120S, S33.121A,S33.121D, S33.121S, S33.130A, S33.130D, S33.130S, S33.131A, S33.131D, S33.131S, S33.140A, S33.140D, S33.140S, S33.141A, S33.141D, S33.141S, S33.2XXA, S33.2XXD, S33.2XXS, S34.21XA, S34.21XD, S34.21XS, S34.22XA, S34.22XD, S34.22XS, S34.4XXA, S34.4XXD, S34.4XXS.
Extraspinal manipulation, also known as extraspinal manipulative therapy (EMT), is used to treat joint dysfunction outside of the vertebral column. Extraspinal regions are the following: head (excluding atlanto-occipital. including temporomandibular joint), Lower extremities, upper extremities, rib cage (excluding costotransverse and costovertebral joints), and abdomen.
Maintenance therapy is defined as a treatment plan that seeks to prevent disease, promote health, and prolong and enhance the quality of life, or as a therapy that is performed to maintain or prevent deterioration of a chronic condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.
AT Acute treatment
Policy: MA03.005b:Modifiers XE, XS, XP, XU, and 59
Policy: MA10.003f:Physical Medicine & Rehabilitation Services: Physical Therapy (PT) and Occupational Therapy (OT)
Policy: MA11.021a:Non-Surgical Spinal Decompression Therapy