Billing and Coding: Cervical Fusion

This billing and coding guidance applies specifically to cervical fusion and related cervical spine procedures and supplements LCD L39773; refer to that LCD for clinical and frequency coverage rules. Claims must include a valid ICD-10-CM code, supporting medical records (legible, signed, with assessment, history, test results, and operative notes), and required referring physician information; use the specified GA/GX/GY/GZ modifiers for ABN and non-covered situations. Inclusion of non-FDA-approved biological injectants (e.g., amniotic/placental products, PRP, vitamins, amino acids) will result in claim denial, and procedure codes may be subject to NCCI or OPPS edits.

"This billing/coding guidance applies only to cervical fusion and related cervical spine procedures and does not apply to other joint or non-cervical spinal procedures (e."

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