BlueCross BlueShield of Tennessee Medical Policy Manual

Manipulation Under Anesthesia (MUA) of the Musculoskeletal System


Manipulation under anesthesia (MUA) is a series of mobilization, stretching, and traction procedures performed while the patient is sedated (usually with general anesthesia or moderate sedation).

Manipulation is intended to break up fibrous and scar tissue to relieve pain and improve range of motion. Anesthesia or sedation is used to reduce pain, spasm, and reflex muscle guarding that may interfere with the delivery of therapies and to allow the therapist to break up joint and soft tissue adhesions with less force than would be required to overcome patient resistance or apprehension. MUA is an accepted treatment for certain isolated joint conditions, such as arthrofibrosis of the knee. It is also used to reduce fractures (e.g., vertebral, long bones) and dislocations, and for temporomandibular joint syndrome.

Spinal manipulation under anesthesia has been explored in the treatment of acute and chronic back and neck pain where there has been limited success of prior attempts to manipulate the spine. Scientific evidence on spinal MUA, spinal manipulation with joint anesthesia, and spinal manipulation after epidural anesthesia and corticosteroid injection is very limited and insufficient to determine the effects on health outcomes.

Note: This policy does not apply to manipulation under anesthesia for adhesive capsulitis (i.e. frozen shoulder). Please refer to the MCG: Release of Adhesive Capsulitis, Shoulder, Closed or Arthroscopic ACG: A-0526 (AC).





American Association of Manipulation Under Anesthesia Providers. (2014, February). Guidelines for the practice and performance of manipulation under anesthesia. Chiropractic & Manual Therapies, 22 (7), 1-7.

BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2018). Manipulation under anesthesia. (8.01.40). Retrieved July 5, 2018 from BlueWeb. (11 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Medical Policy Reference Manual. (2:2018). Temporomandibular Joint Dysfunction. (2.01.21). Retrieved July 5, 2018 from BlueWeb. (35 articles and/or guidelines reviewed)




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