Does S9090 require prior authorization?

Yes, S9090 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for S9090?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Backwork Sign up free

`S9090`, Vertebral axial decompression, per session

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

No explicit documentation requirements are specified in this Clinical Policy Bulletin.
Implied/typical documentation (NOT specified in CPB): diagnosis, treatment plan, records of supervised traction sessions, and clinical rationale would be relevant, but the CPB does not state required documentation elements.

Key Coverage Criteria

Inferred (from policy text): Supervised mechanical lumbar traction provided by physicians or physical therapists as part of conservative treatment for low back pain (typically delivered in conjunction with other therapeutic procedures) — standard treatment described as up to 4 sessions per week.
Note: The policy addresses lumbar traction devices generally but does NOT list any specific device-based indications as medically necessary; instead it identifies numerous device types as experimental/investigational (see Limitations).
Cervical mechanical traction is considered medically necessary in the clinic setting for patients who meet ALL of the following criteria: Failure of other evidence-based therapeutic procedures to resolve symptoms after 3 weeks; Only used in combination with other evidence-based treatments including therapeutic exercise (the therapeutic exercise(s) should not cause aggravation or peripheralization of symptoms); Patient has cervical radiculopathy diagnosis with at least 3 of the following findings [...]
Lumbar mechanical traction is considered medically necessary in the clinic setting for patients who meet ALL of the following criteria: Failure of other evidence-based therapeutic procedures to resolve symptoms after 3 weeks; Only used in combination with other evidence-based treatments including therapeutic exercise with extension movements (the therapeutic exercise(s) should not cause aggravation or peripheralization of symptoms); Patient has sciatica or signs of nerve root compression and eit [...]
When the above criteria are met, CPT 97012 (Application of a modality to 1 or more areas; traction, mechanical) is considered medically necessary.
The service is aimed at diagnosis, and treatment of musculoskeletal and related disorders and the effects of these on the nervous system and general health

16 Active Policies

ANTHEM-SURG.00008, Mechanized Spinal Distraction Therapy

EVICORE-HPLAN-HAP-AB9D421BCDBD, Health Alliance Plan MSK Code List - Effective 01/01/2026

CARELON-physical-therapy-occupational-therapy-and-speech-therapy-2024-04-14, Physical Therapy Occupational Therapy and Speech Therapy

UHC-POL-motorized-spinal-traction, Motorized Spinal Traction

AETNA-CPB-0569, Lumbar Traction Devices

AETNA-CPB-0180, Vertebral Axial Decompression

BCBSIL-THE803.021, Vertebral Axial Decompression

BCBSMT-THE803.021, Vertebral Axial Decompression

BCBSNM-THE803.021, Vertebral Axial Decompression

BCBSOK-THE803.021, Vertebral Axial Decompression

REGENCE-MED45, Vertebral Axial Decompression

UMR-POL-UMR-motorized-spinal-traction, Motorized Spinal Traction

SUREST-POL-SUREST-motorized-spinal-traction, Motorized Spinal Traction

CIGNA-CPG275, Axial/Spinal Decompression Therapy/Mechanical Traction (Provided in a Clinic Setting)

CIGNA-CPG278, Chiropractic Care

CIGNA-CPG135, Physical Therapy

`S9090`, Vertebral axial decompression, per session

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

S9090, Vertebral axial decompression, per session

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

16 Active Policies

Related Codes

Have a follow-up question?

`S9090`, Vertebral axial decompression, per session