CMM-613: Thoracic Decompression and Discectomy

Covered for urgent/emergent thoracic neural compression (e.g., unstable fractures, cord compression/myelopathy, progressive/severe motor deficits, incontinence, epidural hematoma, infection, neoplasm, or incapacitating pain) and for non‑urgent primary or repeat decompression/discectomy for radiculopathy or myelopathy only when strict criteria are met; isolated annular tears, disc bulge without neural impingement, degenerative disc disease, concordant discography/MR spectroscopy findings, and percutaneous/laser/minimally invasive thoracic discectomy techniques are considered not medically necessary or investigational. Key requirements: recent (≤6 months) concordant MRI/CT, documented objective and subjective findings, exclusion of other pain sources, absence of unmanaged significant behavioral health disorders (unless urgent), failure of ≥2 conservative therapies for radiculopathy, and for repeat surgery >12 weeks since prior procedure with prior symptom relief (urgent cases may bypass conservative care and behavioral health requirements).