CMM-604 Posterior Cervical Fusion

Posterior cervical fusion (with or without decompression or osteotomy) is medically necessary for urgent/emergent indications (e.g., unstable fractures/dislocations, central cord syndrome, myelopathy with cord signal change, progressive neurological deficit, bowel/bladder incontinence), for symptomatic cervical spondylosis with documented instability, congenital/acquired instability, pseudoarthrosis, implant failure/malposition, and after failed disc arthroplasty, while procedures that do not meet criteria or performed solely for annular tear, isolated non‑compressive disc bulge, degenerative disc disease, concordant discography/MR spectroscopy, or stand‑alone facet devices are not medically necessary. Key requirements include appropriate imaging (plain and flexion/extension X‑rays with instability defined as >3.5 mm translation or >11° angulation or corresponding MRI/CT findings), documentation of failed conservative therapy for non‑urgent cases, nicotine‑free status (never smoker or cotinine ≤10 ng/mL after ≥6 weeks), absence of unmanaged significant mental/behavioral health disorders, and required timing intervals (often >6 months since prior fusion/disc arthroplasty for repeat or pseudoarthrosis indications).