CMM-606: Lumbar Microdiscectomy (Laminotomy, Laminectomy, or Hemilaminectomy) Guidelines

Covers initial and repeat lumbar microdiscectomy (laminotomy/laminectomy/hemilaminectomy) for neurogenic claudication, radiculopathy, and specified urgent/emergent conditions (e.g., cauda equina, progressive neurologic deficit, infection, epidural hematoma, tumor-related compression); excludes procedures done without criteria, isolated annular tears, degenerative disc disease, concordant discography or MR spectroscopy indications, laser technique, and percutaneous (indirect visualization) discectomy (EIU). Key requirements: concordant MRI/CT and objective exam findings, documentation of failure of at least two conservative treatments (usually 6 weeks each) unless urgent/emergent, repeat procedures >12 weeks after prior surgery, absence of unmanaged significant mental/behavioral health disorders, and performance by a credentialed spine surgeon (endoscopic procedures require hospital/ASC surgical privileges).

"Imaging findings noted in the applicable procedure section(s) are required (MRI/CT showing neural structure compression at the requested level(s) concordant with symptoms and physical exam findings)."