CMM-602: Cervical Total Disc Arthroplasty

Cervical total disc arthroplasty is medically necessary for carefully selected skeletally mature adults (typically age 18–60) with symptomatic radiculopathy or myelopathy at C3–C7 (single-level or contiguous two-level initial procedures, and single-level adjacent-segment replacement ≥6 months after prior TDA) and is not medically necessary for indications such as degenerative disc disease as the sole indication, revision at the same level, DEXA T‑score < -1.5, active infection, severe spondylosis/facet arthropathy, OPLL, metabolic/autoimmune bone disease, or other listed contraindications. Coverage requires an FDA‑approved device used per labeling, concordant MRI/CT and flexion/extension X‑rays demonstrating no clinically significant instability (translation ≤3.5 mm; sagittal angulation ≤11°), no prior surgery at the index level, documentation of objective exam findings concordant with imaging, absence of unmanaged significant mental/behavioral health disorders, prior authorization, and—for non‑urgent radiculopathy—failure of ≥2 conservative treatments (each ≈6 weeks) unless contraindicated.