Billing and Coding: Cervical Fusion

This billing and coding policy covers cervical fusion only when the procedure meets the reasonable and necessary clinical criteria and frequency limits in LCD L39788. Claims must include valid ICD-10-CM diagnosis codes, supporting medical records (operative notes, assessments, test results), and required provider identifiers; inclusion of non–FDA-approved biological injectants at surgery will result in denial of the entire claim. Coding is subject to AMA CPT guidance and to NCCI/OPPS edits, and appropriate ABN-related modifiers (GA/GX/GY/GZ) must be used for non-covered or expected-to-be-denied services.

"Cervical fusion procedures are covered when they meet the reasonable and necessary clinical criteria and frequency limits specified in Local Coverage Determination (LCD) L39788."

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