Disc Decompression Procedures

This policy covers conventional open discectomy and microdiscectomy (with or without loupe/microscope) for adults (≥18) with imaging‑confirmed symptomatic lumbar disc herniation compressing nerve roots or the spinal cord, particularly patients with radiculopathy and objective motor deficit (MRC ≤3) or MRC = 4 with documented worsening or failure of conservative therapy. Coverage requires documented imaging and specified conservative therapy within the prior year (e.g., ≥4 weeks physical therapy or prescribed home exercise or documented inability to tolerate, ≥4 weeks activity modification, ≥3 weeks NSAID/acetaminophen unless contraindicated; epidural steroid injection only per policy criteria), excludes members <18, and considers percutaneous/laser/endoscopic/minimally invasive discectomy techniques and interspinous spacers investigational or not preferred.

"Open discectomy or microdiscectomy for symptomatic lumbar disc herniation where a portion of the intervertebral disc is compressing the nerve root or spinal cord."