BlueCross BlueShield of Tennessee Medical Policy Manual

Piezoelectric Sensor Analysis and Oscillating Force Delivered Vertebral Adjustment in the Evaluation and Treatment of the Spinal Column

DESCRIPTION

Piezoelectric sensor (i.e., piezoelectric accelerometer) technology is being utilized for the purpose of analyzing the mobility of each segment of the spinal column. Piezoelectric measuring systems have been historically used by industry in the measurement of force, pressure, acceleration, vibration, and/or strain (e.g., pressure changes in liquids and gases such as in shock tube studies, industrial machinery vibration monitoring and diagnosing out-of-balance conditions/displacement of rotating parts). As used in the evaluation/assessment of the spinal column, piezoelectric sensor technology is intended for the purpose of determining if normal motion is occurring in the spine. The instrument is placed against a segment of the spinal column and a vibratory pulse is emitted by the device. The reading is recorded and graphically displayed on a computer screen and the waveform presented reportedly indicates the degree of rigidity (i.e., fixation, mechanical impedance) of each vertebra that is tested.

As a treatment for the spinal column, oscillating force is an instrument delivered vibratory adjustment used for the purpose of increasing the mobility of each treated spinal vertebra by reducing or eliminating fixation (i.e., mechanical impedance). It is possible that separate devices could be used in the application of the piezoelectric sensor technology and/or oscillating force; however, at present the primary device marketed for these purposes, the Pro-Adjuster® (i.e., S.M.A.R.T.-Adjuster®), utilizes the same tuning fork like hand-held instrument for the spinal piezoelectric sensor analysis and the oscillating force delivered adjustment. The device is used as both a diagnostic instrument and as a therapeutic instrument.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

There is an absence of adequate peer-reviewed literature demonstrating the effectiveness of piezoelectric sensor (i.e., piezoelectric accelerometer) technology in the treatment and evaluation of the spinal column. Comparative studies of this technology to current standard chiropractic treatments are not available.

No current references to the technology were found in a search of the following professional organizations:

SOURCES

BlueCross BlueShield of Tennessee network physicians. January 2005.

Complete Guide to Medicare Coverage Issues [Computer software]. (2013, April). Coverage of Chiropractic Services (Section 240.1, p. 4-243 - 4-245). OptumInsight, Inc.

Tennessee Code: Title 63: Professions of the Healing Arts: Chapter 4 Chiropractors: 63-4-101. Chiropractic and chiropractic physicians defined – Education and clinical training-scope of practice. Retrieved September 16, 2010 from http://www.michie.com/tennessee/lpext.dll?f=templates&fn=main-h.htm&cp=tncode.

U.S. Food and Drug Administration. (1997, January). Center for Devices and Radiological Health. 501(k) Premarket Notification Database. K962239. Retrieved September 16, 2010 from http://www.accessdata.fda.gov/cdrh_docs/pdf/K962239.pdf.

U.S. Food and Drug Administration. (2005, June). Center for Devices and Radiological Health. 501(k) Premarket Notification Database. K050428. Retrieved September 16, 2010 from http://www.accessdata.fda.gov/cdrh_docs/pdf5/K050428.pdf.

U.S. Food and Drug Administration. (2008, April). Center for Devices and Radiological Health. 501(k) Premarket Notification Database. K080261. Retrieved September 16, 2010 from http://www.accessdata.fda.gov/cdrh_docs/pdf8/K080261.pdf.

ORIGINAL EFFECTIVE DATE:  6/11/2005

MOST RECENT REVIEW DATE:  7/11/2013

ID_BT

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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