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OPD Procedure: Cervical Fusion with Disc Removal
This surgical procedure may relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, and tingling. The procedure is accompanied by a fusion surgery to stabilize the spine.
Medical Necessity
Services are considered reasonable and medically necessary in patients experiencing one or more of the following:
- Indications for cervical fusion may include but is not limited to:
- Neurological dysfunction in the presence of spinal cord compression
- Cervical instability
- Cervical spinal stenosis (myelopathy)
- Fractures/trauma
- Spinal deformities
- Emergency situations/indications that do not require conservative therapy
- Progressive neurological compromise/deficits
- Unstable spinal fracture/dislocations
- Progressive/clinically significant spinal deformity
- Persistent debilitating pain daily
- Neck pain with associated symptoms such as numbness, tingling, and weakness
- Failure to respond to conservative therapy such as exercise plan, pharmacological, PT/OT therapy, etc.
General Documentation Requirements
- Clinical evaluations related to the patient’s pain
- Current H&P, office visit notes or physician progress notes
- Radiological imaging studies (CT, MRI, X-ray) confirming diagnosis/diagnoses and validated by a physician
- Documentation related to previous conservative treatments tried
- Documentation on how their pain affects their ADLs
- For emergency situations/ indications that do not require conservative therapy
- Radiological imaging studies
- Physical findings and imaging studies correlate
Prior Auth Request Form
Prior Authorization OPD: Cervical Fusion with Disc Removal
Coverage Criteria and Resources
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