Spinal Surgery: Laminectomy and Fusion

Aetna covers cervical, thoracic, lumbar (and sacral) laminectomy ± discectomy/fusion and cervical laminoplasty for herniated discs, stenosis, fractures, infection, tumors, hematoma, cysts or other mass lesions when imaging shows moderate-to-severe central/lateral recess or foraminal stenosis or nerve/spinal cord compression at the treated level(s), but deems laminoplasty contraindicated with >3 mm cervical motion or any cervical kyphosis and treats exploration of fusion as incidental/not separately reimbursable. Key requirements: documented failure of ≥6 weeks of recent conservative therapy (PT, medications, patient education, mental‑health management as appropriate) unless waived for urgent indications (e.g., spinal cord compression, cauda equina, myelopathy, severe or progressive neurological deficit, instability when fusion requested, or documented PT failure), and elective fusion patients must be nicotine‑free for ≥6 weeks (or have lab nicotine ≤10 ng/ml).