CMM-600: Preface to the Spine Surgery Guidelines

This preface requires prior authorization for elective and urgent/emergent spinal surgeries (including fusion and disc arthroplasty) and explicitly excludes discography/MR spectroscopy as determinants of medical necessity; urgent/emergent requests may waive timing and smoking-cessation requirements in cases such as fusion, disc arthroplasty, or myelopathy. Key requirements include submission ≥2 weeks before elective surgery, detailed documentation (CPT/ICD codes, independent CT/MRI/myelography reports, provider-directed non‑surgical treatment trials or documented contraindications, flexion‑extension X‑rays for fusion), nicotine‑free verification (never-smoker or ≥6 weeks cessation with blood cotinine ≤10 ng/mL) and trials of ESIs/SNRBs unless contraindicated (e.g., allergy, altered epidural space, anticoagulation/bleeding disorder, local/systemic infection, or steroid‑exacerbating comorbidities).

"Prior authorization for elective spinal surgery (Prior-authorization requests should be submitted at least two weeks prior to the anticipated date of an elective spinal surgery)."