SURG.00111 Axial Lumbar Interbody Fusion

This policy addresses axial or presacral axial lumbar interbody fusion (AxiaLIF), a percutaneous trans-sacral fusion technique for L5–S1 or L4–S1 (e.g., AxiaLIF and AxiaLIF II/2-Level systems). Anthem considers axial/presacral LIF investigational/experimental and not medically necessary; it is not covered. This noncoverage applies to all indications and devices/approaches, including services billed under CPT/HCPCS 22586, 22899, 00111, E1296, and E1301, with no exceptions.

"Axial or presacral lumbar interbody fusion is consideredinvestigational and not medically necessary."

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