Archived Policies - Therapy


Spinoscopy, Motion Analysis

Number:THE803.015

Effective Date:05-01-1996

End Date:05-14-2007

Coverage:

Coverage will not be provided for this procedure since it is not medically necessary. This is not an endoscopic procedure but a form of motion analysis in which measurements are obtained based on constant pulsating light. If a patient has muscle spasm, radicular irritation, or even a direct trauma with an acute hematoma and strain, motion will be altered. This information is easily available and should be a routine part of every physical examination.

Description:

Several light emitting diodes are placed on the spinal joints as specific levels and one on each heel.  Cameras then record movements from two different angles.

Depending on the information the physician requests, the patient does a series of movements.

  • Standing still
  • Forward bending with or without loads
  • Lateral bend while supporting different loads in each hand
  • Rotating exially while holding various loads

Rationale:

None

Contract:

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Coding:

None


Medicare Coverage:

None

References:

Peer Review Analysis, Inc.

Spino-Tex, Inc. 

Policy History:

Archived Document(s):

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