Billing and Coding: Cervical Fusion

This billing and coding policy applies to cervical fusion and related cervical spine fusion procedures and defers to LCD L39758 for specific reasonable and necessary clinical criteria and frequency limits. Claims must comply with NCCI and OPPS coding edits, include valid ICD-10-CM diagnosis codes, complete and signed medical documentation (including operative notes and supporting test results), and report referring/ordering physician name and NPI when required; inclusion of non-FDA-approved biological injectants will result in claim denial and appropriate ABN/modifier use is required for non-covered services.

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

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