CMM-608: Lumbar Decompression

Covered: open lumbar decompression (initial and repeat) and lumbar corpectomy, with limited use of FDA‑approved interlaminar devices (e.g., Coflex) when criteria are met; excluded or EIU are percutaneous lumbar decompression, interspinous/interlaminar spacers and IPD systems (e.g., Superion, X‑STOP, TOPS), Coflex in many scenarios, and procedures for sole indications such as annular tears, degenerative disc disease, concordant discography, or MR spectroscopy. Key requirements: concordant symptoms, objective exam and MRI/CT evidence of neural compression, failure of ≥2 specified conservative therapies (each ~6 weeks) unless urgent/emergent, credentialed spine surgeon, Coflex limited to 1–2 levels L1–L5 and not with fusion or higher‑grade spondylolisthesis, and repeat decompression >12 weeks since prior surgery (unless urgent).

"Urgent/emergent indications for lumbar decompression: acute/unstable traumatic spinal fractures or dislocations with EITHER neural compression OR traumatic cerebrospinal fluid (CSF) leak."