CMM-604: Posterior Cervical Fusion

Posterior cervical fusion (with/without decompression) is covered for urgent/emergent conditions (e.g., unstable/traumatic fractures or dislocations with neural compression, central cord syndrome, progressive neurologic deficit, significant motor weakness), for radiographic instability (subluxation >3.5 mm or sagittal angulation >11°), and for defined syndromes (radiculopathy, myelopathy, pseudoarthrosis, failed arthroplasty/implant failure, or certain congenital/acquired instability); it is not medically necessary for sole indications such as discogenic axial pain, isolated degenerative disc disease, annular tear, disc bulge without neural impingement, concordant discography/MR spectroscopy alone, or isolated facet fusion/stand‑alone allograft devices. Key requirements include plain x‑rays with flexion/extension views and imaging concordant with exam, documented failure of appropriate conservative therapy for non‑urgent cases, nicotine‑free status (never‑smoker or ≥6 weeks abstinent with blood cotinine ≤10 ng/mL), absence of unmanaged significant mental/behavioral health disorders, and adherence to timing rules (often ≥6 months since prior fusion) — missing these documents renders the procedure not medically necessary.