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June 10, 2024

Cervical Fusion with Disc Removal and Prior Authorization Update


MEDICAL NECESSITY: Currently includes several indications, persistent disability, daily pain, neck pain with associated symptoms, and failure to respond to conservative therapy.

DOCUMENTATION REQUIREMENTS: Clinical documentation related to pain, current H&P, office visit notes, etc., radiologic imaging, documentation related to conservative treatments tried, documentation related to how pain affects ADLs.


INDICATIONS: Three categories

REQUIREMENTS: (must meet ALL of the following)

  • Moderate to severe arm pain (4 or more on VAS or equivalent) – present for a minimum of 12 weeks. Failure to respond to multimodal conservative treatment (as tolerated); AND
  • Nerve compression that negatively impacts ADLS, AND
  • All other sources of pain/neurological deficit have been excluded, AND
  • Imaging that substantiates central, lateral recess or foraminal stenosis at the targeted level

See details in full LCD at:

FOR MORE INFORMATION: Register HereExternal Website for our educational webinar that will be held on June 14, 2024.


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