CMM-600 Preface to the Spine Surgery

CMM-600 requires prior authorization and detailed documentation for EviCore‑managed spine surgeries (elective, urgent/emergent, and spinal fusion) and explicitly excludes discography and MR spectroscopy as determinants of medical necessity. Key requirements include submitting elective requests ≥2 weeks before surgery; CPT/ICD‑10 and level(s); detailed non‑surgical treatment history and responses; independent CT/MRI/myelography radiologist reports (with reconciled discrepancies); trials of ESI/SNRB when indicated unless contraindicated (allergy, altered epidural space, anticoagulation/bleeding disorder, infection, or steroid‑exacerbating comorbidities); flexion‑extension X‑rays for fusion when instability is suspected; and nicotine‑free evidence for planned fusion/disc arthroplasty (cotinine ≤10 ng/mL after ≥6 weeks cessation), while urgent/emergent cases waive many prior‑authorization requirements but still require appropriate imaging findings.

"Written reports/interpretations of the most recent advanced diagnostic imaging studies (e."