Subject:
Home Traction Devices for the Treatment of Spinal Disorders and Pain
Description:
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IMPORTANT NOTE:
The purpose of this policy is to provide general information applicable to the administration of health benefits that Horizon Blue Cross Blue Shield of New Jersey and Horizon Healthcare of New Jersey, Inc. (collectively “Horizon BCBSNJ”) insures or administers. If the member’s contract benefits differ from the medical policy, the contract prevails. Although a service, supply or procedure may be medically necessary, it may be subject to limitations and/or exclusions under a member’s benefit plan. If a service, supply or procedure is not covered and the member proceeds to obtain the service, supply or procedure, the member may be responsible for the cost. Decisions regarding treatment and treatment plans are the responsibility of the physician. This policy is not intended to direct the course of clinical care a physician provides to a member, and it does not replace a physician’s independent professional clinical judgment or duty to exercise special knowledge and skill in the treatment of Horizon BCBSNJ members. Horizon BCBSNJ is not responsible for, does not provide, and does not hold itself out as a provider of medical care. The physician remains responsible for the quality and type of health care services provided to a Horizon BCBSNJ member.
Horizon BCBSNJ medical policies do not constitute medical advice, authorization, certification, approval, explanation of benefits, offer of coverage, contract or guarantee of payment.
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Chronic back pain arises from a variety of etiologies, among which are mechanical disorders involving facet joints, vertebral discs, ligaments and/or bony abnormalities. The back pain associated with these disorders is often treated with nonsteroidal anti-inflammatory medication, muscle relaxants or stronger prescription pain medications for more severe pain, or physical therapy. Spinal traction is often combined with these other forms of treatment.
Traction is the application of a stretch to muscles, ligaments, and tissue to provide relief of pain resulting from a variety of conditions, such as muscle spasm, nerve root compression, osteoarthritis, degenerative joint disease, and others. It involves stretching a body part or separating two body parts from each other by pulling. Traction is frequently used to treat the spine, most often either the cervical or the lumbar spine. When used on the spine, traction stretches tight muscles resulting from back spasm and promotes separation of the intervertebral joint spaces or widening of intervertebral foramen to reduce nerve root compressions in the affected area. The goal of traction is usually short term pain relief, returning the patient to normal range of motion, and return to work.
There are several methods of applying traction: mechanically, pneumatically, manually, using autotraction, and gravitationally. In mechanical traction, a motorized system of weights is attached to the person’s problem area by a harness or sling. Manual traction is applied when a physical therapist uses his/her own body weight to stretch the patient’s problem area. In pneumatic traction, the patient inflates a pneumatic device with a hand pump. In autotraction, the patient pulls on bars or other stationary objects to stretch, while gravitational traction uses tilt tables or similar apparatus.
Patient-operated spinal unloading devices for the lower back, such as the LTX 3000, various pneumatic vests and the Saunders Lumbar HomeTrac, are intended as conservative treatment of subacute and chronic low back pain for patients who have not improved with standard medical therapy or who have failed surgical therapy. These devices provide a traction-like effect by shifting weightbearing off the lower back and onto the hips. Spinal unloading devices for the cervical (neck) region may be administered by various techniques ranging from pneumatic traction utilizing supine mechanical motorized cervical traction to seated cervical traction using an over-the-door pulley support with attached weights to relieve pain in the neck region due to neck muscle spasm or nerve root compression. Some pneumatic devices are worn like a garment or brace. These are inflated by the patient and are designed to lift the patient’s body weight off the spine and relieve intervertebral compression. Some of these devices allow the patient to be ambulatory during treatment (such as the Orthotrac Pneumatic Vest), while others require the patient to remain stationary. The LTX-3000 system is a gravity-dependent spinal uploading device that promotes controlled spinal distraction by suspending the patient in a seated position, with the body weight supported from the rib cage by means of a brace-type device fastened around the lower chest. All of these devices are designed to be used on an intermittent basis, usually two or three times per day. Low-weight (7 to 10 lb) cervical spinal traction, applied for one hour, three times a day has been used as an early treatment of radiculopathy from disc herniation in some studies. The optimal duration of treatment is not well established. Cervical spine traction is typically recommended for 15 to 25 minutes daily for the first week of treatment and then 3 times a week for another 2 to 3 weeks, while lumbar spine traction is usually delivered in eight 40-minute sessions for approximately 3 to 4 weeks.
Home traction units generally provide sustained (static) or intermittent distractive forces. Some devices intended primarily for home use are limited in comparison to those usually available in supervised outpatient settings. Traction forces used in the clinic setting commonly reach between 20 and 50 pounds. The traditional over-the-door traction units (applied in a supine position) are generally limited to providing less than 20 pounds of traction. More recently developed technologies include the Pronex and Saunders HomeTrac devices which are used in the supine position, do not cause pressure to the temporomandibular joint, and reportedly provide cervical traction in the home using forces comparable to those in the outpatient setting.
Some of the most commonly used lumbar traction techniques are not suited for home use. Manual traction (distractive force is exerted by and under the control of the clinician) and motorized traction (distractive force is exerted by a motorized pulley) are not practical for home application. There are also questions about the ability of some lumbar traction devices designed for home use to achieve the magnitude of distractive force (80-120 lbs or >50% of body weight) necessary to increase intervertebral joint space. The Saunders HomeTrac and Saunders ST are home lumbar traction devices that according to the manufacturer can apply up to 200 pounds of home traction force. The device reportedly mimics the traction offered in a clinical setting by providing a friction-free split surface that actively moves, enabling vertebral separation by inducing a pulling force.
Home traction devices are classified as Class I devices by the U.S. FDA. This classification only requires registration with the FDA prior to marketing and does not require neither a 510(k) clearance nor submission of clinical data regarding efficacy. The FDA describes these devices as follows: " A nonpowered orthopedic traction apparatus is a device that consists of a rigid frame with nonpowered traction accessories, such as cords, pulleys, or weights, and that is intended to apply a therapeutic pulling force to the skeletal system."
Related policies:
- Thoraco-Lumbo-Sacral Orthosis with Pneumatics (Policy #026 in the DME Section)
- Vertebral Axial Decompression (Policy #014 in the Allied Health Section)
Policy:
(NOTE: For Medicare Advantage, Medicaid and FIDE-SNP, please refer to the Coverage Sections below for coverage guidance.)
The use of home traction devices in the treatment of spinal disorders is considered investigational because there is insufficient evidence from published, peer-reviewed studies to conclude that the use of home traction devices is effective in the management of neck or low back pain or that it improves net health outcomes. The indications for clinical application, patient selection criteria, risks, and comparison to alternative technologies have not been established for home traction therapy.
Medicare Coverage:
Per NCD 280.1 for Durable Medical Equipment Reference List, traction equipment is covered if the individual has orthopedic impairment requiring traction equipment that prevents ambulation during the period of use. (Cervical traction collars are considered covered under braces, not traction.) For addition information, refer to NCD 280.1 for Durable Medical Equipment Reference List. Available to be accessed at CMS National Coverage Determinations (NCDs) Alphabetical Index search page: https://www.cms.gov/medicare-coverage-database/indexes/ncd-alphabetical-index.aspx.
Per LCD L33823, cervical traction devices (E0840-E0855 and E0860) are covered when LCD L33823 and Article A52476 criteria are met. HCPCS code E0856 describes a cervical traction device that can be used with ambulation, and therefore, is noncovered. For additional information and eligibility, refer to LCD L33823 and Article A52476 below.
Local Coverage Determination (LCD): Cervical Traction Devices (L33823). Available to be accessed at Noridian Healthcare Services, LLC, (DME MAC), Local Coverage Determinations (LCDs) search page: https://www.cms.gov/medicare-coverage-database/indexes/lcd-list.aspx?Cntrctr=389&ContrVer=1&CntrctrSelected=389*1&s=38&DocType=All&bc=AggAAAAAAAAAAA%3d%3d&#ResultsAnchor.
Local Coverage Article: Cervical Traction Devices - Policy Article (A52476). Available to be accessed at Noridian Healthcare Services, LLC, (DME MAC), Local Coverage Determinations (LCDs) search page: https://www.cms.gov/medicare-coverage-database/indexes/lcd-list.aspx?Cntrctr=389&ContrVer=1&CntrctrSelected=389*1&s=38&DocType=All&bc=AggAAAAAAAAAAA%3d%3d&#ResultsAnchor.
Medicaid Coverage:
For members enrolled in Medicaid and NJ FamilyCare plans, Horizon BCBSNJ applies the above medical policy.
FIDE SNP:
For members enrolled in a Fully Integrated Dual Eligible Special Needs Plan (FIDE-SNP): (1) to the extent the service is covered under the Medicare portion of the member’s benefit package, the above Medicare Coverage statement applies; and (2) to the extent the service is not covered under the Medicare portion of the member’s benefit package, the above Medicaid Coverage statement applies.
[RATIONALE: Cervical and lumbar traction have been utilized to treat many causes of spine-related pain including radiculopathy secondary to herniated disc, narrowing of the intervertebral foramen, degenerative changes resulting in nerve root encroachment, and spondylolisthesis. Beyond these broad clinical indications, the particular characteristics of patient subgroups that are likely to benefit from home traction do not appear to have been identified in clinical studies.
Traction, when applied at home, also presents with factors that may influence clinical effectiveness and the risk of adverse events. The absence of professional supervision decreases confidence that the appropriate amount of force will be consistently applied and the desired angle of pull will be maintained. Another consideration that has the potential to affect treatment response is patient compliance with home-based traction. No matter how clinically effective a therapy is found to be, the treatment process, especially when it is dependent upon home use, is highly dependent on patient compliance.
Although traction has been a commonly used treatment modality and numerous studies have been conducted, there has been little scientific evidence of the effectiveness of traction for cervical neck and/or lumbar back pain. Harte et al (2003) conducted a computer-aided search for randomized controlled trials (RTCs) from 1966 through 2001 to assess the efficacy of traction for treatment of low back pain. The evidence for use of traction in low back pain was inconclusive, and they stated that further trials are needed before firm conclusions and recommendations can be made. Smith et al (2002) performed a literature review and concluded that no evidence was found for use of traction. Beursken et al (1995) conducted a RTC of 151 patients in which high-dose traction was compared to sham traction, and concluded that traction was not promising for any group and that the data do not support the claim that traction is effective for treatment of low back pain. Reust et al (1988) performed a double-blind RTC of 60 patients and concluded there was no significant difference between the treatment groups (placebo traction, light traction, normal traction). In a criteria-based appraisal of review articles, Hoving et al. (2001) found the evidence inconclusive for traction for neck pain and also stated more research is necessary to formulate stronger conclusions. A systematic literature analysis conducted by van der Heijden et al (1995) to assess the efficacy of traction for patients with neck or back pain included RTCs comparing traction with other treatments. They found that no conclusions can be drawn about whether a specific traction modality for back or neck pain is effective, or more efficacious than other modalities, and further that there were no clear indications that traction is an effective therapy. They also concluded that more trials are needed, with close attention to proper design and methodology.
Back:
A study by Janke et al. (1997) suggests that the LTX 3000T device is effective in producing distraction of the lumbar vertebrae, and increasing the lumbar intervertebral disc spaces. However, the duration of the effect has not been determined and there is controversy as to whether this biomechanical effect translates into long-term relief of symptoms or improvement in function. While data provided by the device manufacturers suggest that both the LTX 3000 and the Orthotrac vest may have some beneficial effect, none of the studies were controlled, blinded, or had undergone peer review, so the outcomes may have been subject to substantial bias. In addition, the LTX 3000T was used in conjunction with a comprehensive back rehabilitation program; the possible benefit of the traction device cannot be separated from the effects of exercise, education, and participation in a program that provided support and supervision by healthcare professionals. Other studies have demonstrated the value of education and exercise programs in reducing the occurrence of low back pain, and it may be these components, rather than the LTX 3000T traction-inducing device, that are responsible for the reported beneficial effects. Dallolio (2005) completed a preliminary study using the Orthotrac vest on 41 patients with radicular pain due to degenerative discopathy and stenosis. The results indicate that 78% of the patients showed significant subjective and clinical improvement with subsequent better quality of life. This was not a randomized controlled trial and the measurement system use to report improvement was not documented. The author concludes that the system gives effective spinal decompression but further studies are needed to confirm the preliminary results.
Neck:
Olivero and Dulebohn (2002) conducted a retrospective review of 81 patients receiving halter cervical traction for the treatment of cervical radiculopathy. All patients experienced at least 6 weeks of symptoms before undergoing a trial of traction that consisted of wearing a cervical collar and home-based halter cervical traction: 8 to 12 pounds, applied for 15 minutes, 3 times a day for 3 to 6 weeks. Sixty-three (78%) of 81 patients responded to therapeutic traction, experiencing significant or total pain relief, 3 could not tolerate the traction, and traction failed in 15 patients. Three of the 63 patients who responded to traction therapy, suffered recurrence of their symptoms and required surgery. The authors concluded that 75% of patients with at least a 6 week history of cervical radiculopathy will benefit from home-based halter traction therapy. The study is limited by small sample size and lack of a comparison group. According to the 2010 North American Spine Society (NASS) guidelines for the diagnosis and treatment of cervical radiculopathy from degenerative disease, "this case series did not utilize any validated outcome measures and had very short follow-up period. Due to this weakness, this potential Level IV (case series) study provides Level V (expert opinion) evidence suggesting that 75% of patients with mild radiculopathy may improve with traction over a six week time frame. Swezey et al. (1999) reported that a brief (3-5 min), over-the-door home cervical traction modality provided symptomatic relief in 81% of the patients with mild to moderately severe (Grade 3) cervical spondylosis syndromes. Five patients discontinued treatment after reporting transient symptom aggravation with traction. No serious or sustained adverse events were recorded. The author noted that prospective, randomized assessment of cervical traction for this and other methods is needed.
In addition to the shortcomings of a retrospective design, which did not include a control or comparator group, confidence in the conclusions is very low due to multiple additional methodological shortcomings. The characteristics of the subjects were not well-described. The measurement tool for the primary outcome variable was not described. Comparative data (baseline and follow-up) were not explicitly reported. The duration of treatment effect was not reported. The application of co-interventions was not described. Assessor blinding was not described.
Case series reports have evaluated the relationship between the separation of the vertebral bodies and the amount of traction force and angle of rope pull. Colachis et al. (1965) found that the mean angle of distraction changed based on weight (traction force) and angle of pull. Fater et al. (2008) found that neither seated nor supine cervical traction with the neck in 15 degrees of flexion was effective in increasing anterior vertebral separation. Two additional case reports evaluated the use of cervical traction and the impact on temporomandibular joint (TMJ) disorders. Frankel et al. (1964) found that the use of cervical traction increased TMJ symptoms. Franks (1967) found similar results due to pressure on the temporomandibular joint especially in patients predisposed to osteoarthritic changes
Technology Assessments
Agency for Healthcare Research and Quality (AHRQ):
The conclusions of the 2007 AHRQ's Technology Assessment on Decompression Therapy for the Treatment of Lumbosacral Pain state in part, "Currently available evidence is too limited in quality and quantity to allow for the formulation of evidence-based conclusions regarding the efficacy of decompression therapy as a therapy for chronic back pain when compared with other non-surgical treatment options. Of the studies examined for assessment of efficacy, neither included patients over 65 years of age. Adverse event reporting for decompression therapy is infrequent. There was one case report of an enlargement of an existing disc protrusion, and other studies reported worsening of pain in some patients."
Washington State Department of Labor and Industries:
The 2002 Technology Assessment on Pronex and Home Trac Cervical Traction states in part:, "There is little evidence documenting the efficacy of any type of cervical traction. For traditional cervical traction, there is some evidence in a retrospective study to suggest safety and efficacy, but there is no documentation of efficacy beyond short-term pain reduction. Reviews of controlled-clinical trials and review articles show inconclusive evidence for the effectiveness of traditional traction. In addition, there are no clinical studies directly comparing the Pronex and Saunders cervical traction devices to conventional cervical traction modalities." ..... The technology assessment concluded, "The Pronex and Saunders cervical traction devices are approved for marketing as a form of traction. The scientific evidence for the use of these devices is no better or worse as compared to the over-the-door unit. Although the cost for Pronex or Home Trac is more than the over-the-door unit, they are easier to use and less likely to cause aggravation to the TMJ. Therefore, the department will cover these devices similarly. The recommendation is that all such cervical traction devices be covered with no prior authorization required."
Summary
The use of traction devices in the home setting for treatment of cervical neck pain and/or lumbar spine pain is not supported by evidence in the peer-reviewed medical literature that permits conclusions on the effect of these devices on health outcomes and /or demonstrates an improvement in net health outcome through the use of these devices.
Supplemental Information:
Practice Guidelines and Position Statements
The American Physical Therapy Association (APTA) published a clinical practice guideline regarding low back pain (Delitto, et al., 2013). The guideline reported, “There is conflicting evidence for the efficacy of intermittent lumbar tractions for patients with low back pain. There is moderate evidence that clinicians should not utilize intermittent or static lumbar traction for reducing symptoms in patients with chronic low back pain.”
The North American Spine Society (NASS) guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders notes that regarding the role of traction in the treatment of cervical radiculopathy from degenerative disorders that cervical halter traction and combinations of medications, physical therapy, injections and traction have been associated with improvements in patient reported pain in uncontrolled case series. They note that such modalities may be considered recognizing that no improvement relative to the natural history of cervical radiculopathy has been demonstrated (NASS, 2010).
A joint clinical practice guideline from the American College of Physicians and the American Pain Society for the diagnosis and treatment of low back pain notes that intermittent or continuous traction in patients with or without sciatica have not been proven effective for chronic low back pain (Chou, et al., 2007b).]
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Horizon BCBSNJ Medical Policy Development Process:
This Horizon BCBSNJ Medical Policy (the “Medical Policy”) has been developed by Horizon BCBSNJ’s Medical Policy Committee (the “Committee”) consistent with generally accepted standards of medical practice, and reflects Horizon BCBSNJ’s view of the subject health care services, supplies or procedures, and in what circumstances they are deemed to be medically necessary or experimental/ investigational in nature. This Medical Policy also considers whether and to what degree the subject health care services, supplies or procedures are clinically appropriate, in terms of type, frequency, extent, site and duration and if they are considered effective for the illnesses, injuries or diseases discussed. Where relevant, this Medical Policy considers whether the subject health care services, supplies or procedures are being requested primarily for the convenience of the covered person or the health care provider. It may also consider whether the services, supplies or procedures are more costly than an alternative service or sequence of services, supplies or procedures that are at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of the relevant illness, injury or disease. In reaching its conclusion regarding what it considers to be the generally accepted standards of medical practice, the Committee reviews and considers the following: all credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, physician and health care provider specialty society recommendations, the views of physicians and health care providers practicing in relevant clinical areas (including, but not limited to, the prevailing opinion within the appropriate specialty) and any other relevant factor as determined by applicable State and Federal laws and regulations.
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Index:
Home Traction Devices for the Treatment of Spinal Disorders and Pain
Traction Devices
Lumbar Traction Devices
Cervical Traction Devices
Hometrac
Pronex
Saunders
LTX 3000
LTX-3000
References:
1. Hoving, J.L., Gross, A.R., et al. A critical appraisal of review articles on the effectiveness of conservative treatment for neck pain. Spine (2001 Jan 15) 26(2):196-205.
2. Van der Heijden, G.J., Assendelft, W.J., et al. The efficacy of traction for back and neck pain: a systematic, blinded review of randomized clinical trial methods. Physical Therapy (1995 Feb) 75(2):93-104.
3. Reust, P., Chantraine, A., et al. Treatment of lumbar sciatica with or without neurological deficit using mechanical traction. A double-blind study. Schweizerische Medizinische Wochenschrift (1988 Feb 27) 118(8):271-4.
4. Beurskens, A.J., de Vet, H.C., et al. Efficacy of traction for non-specific low back pain: a randomized clinical trial. Lancet (1995 Dec 16) 346(8990):1596-600.
5. Harte, A.A., Baxter, G.D., et al. The efficacy of traction for back pain: a systematic review of randomized controlled trials. Archives of Physical Medicine and Rehabilitation (2003 Oct) 84(10):1542-53.
6. Smith, D., McMurray, N., et al. Early intervention for acute back pain: can we finally develop an evidence-based approach? Clinical Rehabilitation (2002 Feb) 16(1):1-11.
7. Janke AW, Kerkow TA, Griffiths HJ, et al. The biomechanics of gravity-dependent traction of the lumbar spine. Spine. 1997;22:253-260.
8. Dallolio V. Lumbar spinal decompression with a pneumatic orthesis: Preliminary study. Acta Neurochir Suppl. Jan 1, 2005;92 133-7.
9. Olivero WC, Dulebohn SC. Results of halter cervical traction for the treatment of cervical radiculopathy: retrospective review of 81 patients. Neurosurgical Focus 2002; 12(2).
10. Swezey RL, Swezey AM, Warner K. Efficacy of home cervical traction therapy. American Journal of Physical Medicine & Rehabilitation 1999; 78:30-32.
11. Colachis S, Strohm M. A Study of Tractive Forces and Angle of Pull on Vertebral Interspaces in Cervical Spine. Arch Phys Med 46:820-830, 1965.
12. Fater DC, Kernozek TW. Comparison of cervical vertebral separation in the supine and seated positions using home traction units. Physiother Theory Pract. 2008 Nov-Dec;24(6):430-6.
13. Frankel V, Shore N, Hoppenfeld S. Stress Distribution in Cervical Traction Prevention of Temporomandibular Joint Pian Syndrome.Clin Orth 1964. 32:114-115.
14. Franks A. Temporomandibular Dysfunction Associated with Cervical Traction. Ann Phys Med 1967. 8:38-40.
15. Graham N, Gross A, Goldsmith CH et al. Mechanical traction for neck pain with or without radiculopathy. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD0006408.
16. Van Zundert J, Huntoon M et al. 4. Cervical Radicular Pain. Pain Pract. Jan-Feb 2010;10(1):1-17. Epub 2009 Oct 5. Review.
17. Chou R. Qaseem A, Snow V et al ; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007 Oct 2;147(7):478-91.
18. Vroomen PC, de Krom MC et al. Conservative treatment of sciatica: a systematic review. J Spinal Disord. 2000 Dec;13(6):4639.
19. Clarke J, van Tulder M, Blomberg S et al. Traction for low back pain with or without sciatica: an updated systematic review within the framework of Cochrane Collaboration. Spine 2006 Jun 15;31(14):1591-9.
20. Washington State Department of Labor and Industries Technology Assessment. Pronex and Home Trac Cervical Traction. 08/05/02. Available at: http://www.lni.wa.gov/ClaimsIns/Files/OMD/PronexAndSaundersTA.pdf (accessed 04/08/2011)
21. Agency for Healthcare Research and Quality (AHRQ) Technology Assessment Program: Decompression Therapy for the Treatment of Lumbosacral Pain. Prepared by ECRI Insttitute
Evidence-based Practice Center. April 26, 2007. Available at: https://www.ecri.org/Documents/EPC/Decompression_Therapy_for_Lumbosacral_Pain.pdf (accessed 04/08/2011)
22. ECRI Institute Hotline Response: Home Traction Devices for Treatment of Spinal Disorders and Pain. Published: 07/13/2011.
23. North American Spine Society (NASS) Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care. Diagnosis and Treatment of Cervical Radiculopathy from Degenerative Disc Disease. 2010. Available at: http://www.spine.org/Documents/Cervical_Radiculopathy.pdf
24. UpToDate. Treatment of acute low back pain. Literature review current through September 2016. Topic last updated June 29, 2016.
25. UpToDate. Treatment and prognosis of cervical radiculopathy. Literature review current through September 2016. Topic last updated September 26, 2016.
26. Childs JD, Cleland JA, Elliott JM et al. American Physical Therapy Association. Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008 Sep;38(9):A1-A34. Epub 2008 Sep 1. Erratum in: J Orthop Sports Phys Ther. 2009 Apr;39(4):297.
26. Delitto A, George SZ, Van Dillen LR et al. Orthopaedic Section of the American Physical Therapy Association. Low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):A1-57.
27. UpToDate. Treatment of neck pain. Literature review current through August 2016. Topic last updated June 21, 2016.
28. Isaac Z. Treatment of neck pain. In: UpToDate, Dashe JF (Ed), UpToDate, Waltham, MA. (Accessed on August 9, 2018.)
29. Robinson J, Kothari MJ. Treatment and prognosis of cervical radiculopathy. In: UpToDate, Eichler AF (Ed), UpToDate, Waltham, MA. (Accessed on August 9, 2018.)
30. Robinson J, Kothari MJ. Treatment and prognosis of cervical radiculopathy. In: UpToDate, Shefner JM, Eichler AF (Eds), UpToDate, Waltham, MA. (Accessed on August 21, 2019.)
31. Robinson J, Kothari MJ. Treatment and prognosis of cervical radiculopathy. In: UpToDate, Shefner JM, Goddeau Jr RP(Eds), UpToDate, Waltham, MA. (Accessed on July 23, 2020.)
32. Knight CL, Deyo RA, Staiger TO, Wipf JE. Treatment of acute low back pain. In: UpToDate, Atlas SJ, Kunins L (Eds), UpToDate, Waltham, MA (Accessed on July 23, 2020).
Codes:
The list of codes is not intended to be all-inclusive and is included below for informational purposes only. Inclusion or exclusion of a procedure, diagnosis, drug or device code(s) does not constitute or imply authorization, certification, approval, offer of coverage or guarantee of payment.)
CPT*
HCPCS
E0830
E0840
E0849
E0850
E0855
E0856
E0860
E0941
* CPT only copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
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Medical policies can be highly technical and are designed for use by the Horizon BCBSNJ professional staff in making coverage determinations. Members referring to this policy should discuss it with their treating physician, and should refer to their specific benefit plan for the terms, conditions, limitations and exclusions of their coverage.
The Horizon BCBSNJ Medical Policy Manual is proprietary. It is to be used only as authorized by Horizon BCBSNJ and its affiliates. The contents of this Medical Policy are not to be copied, reproduced or circulated to other parties without the express written consent of Horizon BCBSNJ. The contents of this Medical Policy may be updated or changed without notice, unless otherwise required by law and/or regulation. However, benefit determinations are made in the context of medical policies existing at the time of the decision and are not subject to later revision as the result of a change in medical policy
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