Medicare's answer hasn't changed since 1997
Medicare decided this one almost three decades ago, and the decision still stands.
National Coverage Determination 160.16, titled “Vertebral Axial Decompression (VAX-D)”, took effect April 15, 1997. Its reasoning fits in two sentences: there isn't enough scientific data to support the technique's benefits, so Medicare doesn't cover it.
The determination's title names VAX-D rather than the DRX9000, which reached the FDA in 2006. That doesn't open a door: when FairWarning looked in 2020, Medicare wasn't paying for DRX9000 courses either. If you're on Medicare, plan on paying for decompression yourself, and look at what a self-pay decompression course has cost before you commit.
What a Utah plan says: University of Utah Health Plans
For anyone insured in Utah, this is the document to read first. It's local, and it's recent.
Medical Policy MP-053, “Vertebral Axial Decompression”, was reviewed and revised on 12/18/2025, with its next review set for 12/18/2026. For Commercial and CHIP members it doesn't cover the treatment, calling it “investigational without proven clinical effectiveness.” Healthy U and Health Choice Utah, the plan's Medicaid options, don't cover it either.
MP-053 also shows its homework. It cites Macario and Pergolizzi's 2006 review, the 2013 Cochrane review by Wegner and colleagues, and a 2016 review for AHRQ by Chou and colleagues, which found only low-strength evidence for traction in radicular low back pain.
Here's a wrinkle. University of Utah Health's own spine pages list decompression therapy among the treatments for problems like herniated discs, sciatica and spinal stenosis. That page doesn't say which devices it means, so we won't claim it's the exact treatment MP-053 declines to cover. Still, the two documents side by side are a fair summary of how unsettled decompression is in 2026.
Aetna and the national picture
Aetna's Clinical Policy Bulletin 0180 was last reviewed on 03/24/2026. It's blunt.
Aetna treats vertebral axial decompression as experimental, investigational or unproven, and it names the DRX9000 among the devices under that label. The stated reason is that there's “no adequate scientific evidence that proves that vertebral axial decompression is an effective adjunct to conservative therapy for back pain.”
It gets specific about billing, too. HCPCS S9090, “vertebral axial decompression, per session”, is listed as not covered for the bulletin's indications, and CPT 97012 for mechanical traction appears as a related code. Related isn't a workaround, and if anyone suggests relabeling decompression as 97012 to slip past a denial, treat it as a red flag rather than a coverage answer.
We haven't read every national insurer's policy, and we won't pretend to. Medicare and Aetna are the two national payers we can quote directly, and they agree.
Cigna pays for traction, but not for “decompression”
Cigna's policy is the one that shows how much the label matters.
Coverage policy CPG 275, effective 4/15/2026, says lumbar and cervical mechanical traction can be medically necessary when a list of clinical criteria is met, billed as CPT 97012. Then it says nonsurgical axial/spinal decompression therapy is experimental, investigational and/or unproven, and it spells out that this "includes any motorized mechanical traction device that is promoted as providing 'decompression therapy'" — naming the DRX-9000, Accu-SPINA, VAX-D and IDD Therapy among others. HCPCS S9090 lands in the experimental column.
Read that twice. A powered table pulling on your spine can be a covered service; the same class of table, sold as decompression, is not. The policy itself notes these tables are "classified by the FDA as powered traction equipment".
Is the distinction real? We went through the evidence on both sides in traction vs. spinal decompression.
Paying for it: cash, HSA and FSA
If your plan says no, you're looking at self-pay — and that doesn't have to mean after-tax dollars.
IRS Publication 502 lists it plainly: "You can include in medical expenses fees you pay to a chiropractor for medical care." Publication 969 defines HSA-qualified medical expenses as amounts paid for medical care under Code section 213(d), and a health FSA reimburses the same category. Chiropractic care sits inside it.
So decompression is usually paid by cash or card, an HSA, or an FSA. What we can't tell you is whether your administrator will approve a particular charge; some ask for documentation, and a letter of medical necessity from Dr. Cody Mecham is a reasonable thing to request at the exam.
Two questions worth asking on the same day: what the full plan costs if you pay cash, and whether the clinic can give you an itemized receipt with the diagnosis and the service on it. That receipt is what an HSA or FSA administrator usually wants to see.
The pricing side is on what spinal decompression costs in Salt Lake City.
Why insurers keep saying no
Coverage decisions follow evidence reviews. On decompression, the reviews have been unkind.
Macario and Pergolizzi's 2006 review in Pain Practice covered prospective trials published between 1975 and October 2005. MP-053 summarizes it as 10 studies, 7 of them randomized, with 6 of the 7 randomized trials finding no difference from motorized decompression. The authors' own verdict was that efficacy “remains unproven”.
Seven years later came the Cochrane review. Wegner and colleagues searched to August 2012, pooled 32 randomized trials covering 2,762 people, and found that traction, alone or combined with other treatment, had little or no effect on pain intensity, function, overall improvement or return to work. That held for people with sciatica and without it, which matters if you're looking into decompression for a herniated disc or sciatica.
So are the insurers being unreasonable? We don't think so. The evidence is thin, which is exactly why Mecham Chiropractic tests decompression against a checkpoint at treatments 8 to 12 instead of asking anyone to take it on faith; the full case is on what the research says about spinal decompression.
How to check your own plan before you book
Don't take a clinic's word for your coverage, ours included. Pick a day you don't mind sitting on hold (a January inversion day, when nobody wants to be outside anyway), call the member services number on your card, and work through these:
- Is vertebral axial decompression, billed as HCPCS S9090, a covered service on my plan?
- If it isn't, which medical policy says so, and can you send me a copy?
- Is there an exception or appeal process for services the plan calls investigational?
- Can I have the answer in writing, with the representative's name and a reference number?
Write the date down. Policies get reviewed on a schedule, and MP-053 is due again in December 2026.
A friendly “you should be fine” from a phone queue isn't coverage. A written answer is.
When the back pain started with a car accident
That's a different conversation, and we'll keep it short, because the answer depends on your claim.
Mecham Chiropractic bills Utah personal injury protection (PIP) for care after car accidents. What PIP will pay for in your case, decompression included, isn't something this page can tell you. Call (801) 590-8615 or book with the clinic before your first visit, and have your claim details ready.