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The magnetically controlled growing rods (e.g., the Phenix growing rod) (except for the MAGEC System).Posterior dynamic deformity correction devices (e.g., ApiFix) for the treatment of adolescent idiopathic scoliosis.See also CPB 0107 - Chiropractic Services.Īetna considers whole body vibration experimental and investigational for the treatment of scoliosis because its effectiveness has not been established.Īetna considers ScoliScore and other genetic testing (e.g., the CHD7 gene, estrogen receptor beta (ESR2) rs1256120 single nucleotide polymorphism (SNP) testing, insulin-like growth factor 1 (IGF1) gene rs5742612 SNP testing, the matrilin-1 gene (MATN1), melatonin receptor 1B gene (MTNR1B) rs4753426 and rs10830963 polymorphism testing, and the transforming growth factor beta 1 (TGFB1) gene not an all-inclusive list) experimental and investigational for predicting progression of adolescent idiopathic scoliosis because their effectiveness has not been established.Īetna considers screening for adolescent idiopathic scoliosis experimental and investigational because the its clinical value has not been established.Īetna considers ultrasound shear wave elastography experimental and investigational for identification of children at risk for idiopathic scoliosis because the effectiveness of this approach has not been established.Īetna considers the following interventions for the treatment of scoliosis experimental and investigational because their effectiveness has not been established: See also CPB 0569 - Lumbar Traction Devices.Īetna considers vertebral body stapling and vertebral body tethering experimental and investigational for the treatment of scoliosis because its effectiveness has not been established.Īetna considers resistive exercises (including the Schroth method) experimental and investigational for the treatment of scoliosis because their effectiveness for this indication has not been established.Īetna considers spinal manipulation experimental and investigational for the treatment of adult scoliosis because its effectiveness for this indication has not been established.
Radiologik dj in russian serial#
Note: Seven inpatient days are considered medically necessary initially for pre-operative inpatient cranial skeletal traction, and additional days of pre-operative inpatient cranial skeletal traction may be considered medically necessary on a case-by-case basis with documented response to traction with improved alignment on serial imaging.Īetna considers spinal unloading devices (e.g., LTX 3000, Orthotrac) experimental and investigational for treatment of scoliosis because their effectiveness has not been established. Pre-operative inpatient cranial skeletal traction (e.g, halo-gravity traction) is considered medically necessary as an adjunct to surgery for the treatment of idiopathic scoliosis when criteria for spinal fusion are met.
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Please note this includes the MAGEC System but does not apply to other expandable magnetic growing rods (e.g., Phenix Growing Rod device) which are considered investigational and experimental.Īetna considers the following types of braces and casts medically necessary durable medical equipment (DME) for the treatment of scoliosis: Idiopathic scoliosis with curve greater than or equal to 50 degrees in a young adult age 18 to 25.Īetna considers idiopathic scoliosis surgery experimental and investigational when these criteria are not met.Īetna considers growing rods technique medically necessary in the treatment of idiopathic scoliosis for persons who meet criteria for surgery above.
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Idiopathic scoliosis with curve greater than or equal to 40 degrees in an adolescent younger than age 18 or.Aetna considers surface electrical muscle stimulators (direct or alternating current, not high-voltage galvanic current) experimental and investigational for the management of idiopathic scoliosis because there is inadequate evidence of its effectiveness and safety in the peer-reviewed published medical literature.Īetna considers surgery (e.g., spinal fusion with instrumentation and bone grafting) for the treatment of idiopathic scoliosis medically necessary for any of the following conditions: