Notification of Informational Update of Policy Revisions Effective July 18, 2023 (Posted July 11, 2023)

Informational update for new policy creation, Cervical Spine Procedures. The coverage criteria for when Cervical Discectomy, Cervical Microdiscectomy, Cervical Foraminotomy, Cervical Laminotomy, Anterior Cervical Fusion, Posterior Cervical Fusion and Cervical Laminectomy requests comes from the sources listed in the Scientific Background and Reference Sources section of the policy and can be found in the When Cervical Spine Procedures are covered section of the policy. The evidence is also listed in the below policies that was in use prior to the creation of the Cervical Spine Procedures policy.

S-310-NC Cervical Diskectomy or Microdiscectomy, Foraminotomy, Laminotomy

S-320-NC Cervical Fusion, Anterior

S-330-NC Cervical Fusion, Posterior

S-340 Cervical Laminectomy

These guidelines will be archived on 7/18/2023.

Informational update: Lumbar Spine Fusion Surgery Policy. Policy renamed Lumbar Spine Procedures and expanded to include coverage criteria for: Lumbar Laminotomy, Foraminotomy, and Diskectomy, Lumbar Laminectomy, and Removal of Posterior Spinal Instrumentation. The coverage criteria for the additional added procedures are listed in the When Lumbar Spine Procedures are covered section of the policy. The Scientific Background and Reference Sources section of the policy has been updated to reflect the evidence used for criteria coverage.  The evidence is also listed in the below policies that was in use prior to the updates to the Lumbar Spine Fusion Surgery policy.

S-530 Removal of Posterior Spinal Instrumentation

S-810-NC Lumbar Diskectomy, Foraminotomy, or Laminotomy

S-830-NC Lumbar Laminectomy

These guidelines will be archived on 7/18/2023.