22858
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
8.19
Facility
$449.24
Non-Facility
$449.24
Documentation Required
- Claims and coding for cervical disc replacement must follow the Local Coverage Determination (LCD) L38033 and the billing/coding guidelines in this article.
- Documentation must show the CDR device used is FDA-approved for the treated indication (including 2-level approval if applicable).
- Imaging documentation (CT, myelography, or MRI) demonstrating corresponding nerve root or spinal cord compression must be included in the medical record.
- Medical records must document at least 6 weeks of failed conservative non-operative treatment when applicable, including physician-directed pain management and physical therapy.
Key Coverage Criteria
- The prosthetic cervical disc device is FDA-approved for the indicated use.
- The beneficiary is skeletally mature.
- The beneficiary has intractable cervical radicular pain or cervical myelopathy that has failed at least 6 weeks of conservative non-operative treatment including physician-directed pain management (e.g., pharmacotherapy for neuropathic pain) and physical therapy.
- Alternatively, the beneficiary has severe or rapidly progressive symptoms of nerve root or spinal cord compression requiring hospitalization or immediate surgical intervention.
- There must be clinical evidence of corresponding nerve root or spinal cord compression documented by CT, myelography, or MRI.
- Cervical degenerative disc disease (CDDD) at a single level between C3 and C7.
8 Active Policies
UHC-POL-total-artificial-disc-replacement-spine — Total Artificial Disc Replacement for the Spine
A57021 — Billing and Coding: Cervical Disc Replacement
L38033 — Cervical Disc Replacement
CARELON-level-of-care-for-surgical-procedures-2025-11-15 — Level of Care for Surgical Procedures
CARELON-spine-surgery-2024-01-01 — Spine Surgery
Related Codes
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