CMM-609: Lumbar Fusion (Arthrodesis)

EviCore covers lumbar fusion and specified osteotomies only for narrowly defined indications—actual or anticipated instability, adult and pediatric spinal deformity, spondylolisthesis/spondylolysis with instability, select single‑level disc herniations, adjacent‑segment disease, failed disc arthroplasty, repeat fusion, and urgent/emergent instability—while excluding fusion for isolated disc herniation without those criteria, multi‑level degenerative disc disease without instability, neurocompressive or facet disease alone, spondylolysis without spondylolisthesis, and numerous procedures/devices deemed experimental or investigational. Approval requires imaging documenting the specific instability/deformity criteria, documentation of candidacy for decompression per CMM‑608 when applicable, required conservative treatment durations (commonly ≥3 months or longer for discogenic pain), proof of nicotine‑free status, absence of unmanaged mental/behavioral health disorders, operative plans showing anticipated iatrogenic instability, and adherence to specified timing/prior‑surgery minima.