CMM-614: Thoracic and Thoracolumbar Fusion (Arthrodesis)

Thoracic and thoracolumbar fusion and adjunctive osteotomies (PCO—limited to 4 per correction except Scheuermann’s—and three‑column osteotomies such as PSO/VCR) are covered only when specific imaging and clinical criteria are met (e.g., required Cobb angles and flexibility, fixed sagittal correction needs >30° for PSO, instability by dynamic films or >3 mm translation or Meyerding ≥II, pediatric thresholds like AIS >50°, and adjacent‑segment/repeat timing rules; urgent/emergent exceptions apply). Coverage requires documented imaging, prior conservative therapy when specified (generally ≥3 months), nicotine‑free status (never‑smoker or blood cotinine ≤10 ng/mL after ≥6 weeks), and absence of unmanaged behavioral health issues where required; procedures not meeting criteria are not medically necessary and endoscopic/percutaneous fusion, isolated facet fusion/arthroplasty, and non‑FDA implants are considered experimental/investigational.

"Thoracic or thoracolumbar posterior column osteotomy (PCO) (i."