Billing and Coding: Cervical Fusion

Coverage for cervical fusion is permitted only when the reasonable and necessary clinical criteria and frequency limits in LCD L39738 are met. Claims must include a valid ICD-10-CM code, appropriate CPT/HCPCS coding (subject to NCCI/OPPS edits), and comprehensive, signed medical documentation supporting medical necessity; inclusion of non–FDA-approved biological injectants (e.g., amniotic/placenta-derived products, PRP, vitamins) will result in denial of the entire claim. Use the appropriate ABN-related modifiers (GA, GX, GY, GZ) per the circumstances, and report referring physician name and NPI when required.

"Cervical fusion and related procedures are covered when they meet the reasonable and necessary clinical criteria and frequency limits specified in Local Coverage Determination (LCD) L39738."

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