CMM-608: Lumbar Decompression

eviCore covers initial and repeat lumbar decompression only when strict criteria are met and excludes procedures done solely for non‑concordant imaging findings, annular tear, disc bulge without neural impingement, degenerative disc disease, and specific experimental/investigational procedures/devices (e.g., percutaneous/laser discectomy, Vertos MILD®, and interspinous/interlaminar devices such as X-STOP, Superion, Coflex, TOPS). Key requirements: concordant symptoms and objective exam with MRI/CT within 6 months, failure of ≥2 conservative therapies unless contraindicated, absence of unmanaged significant mental/behavioral health disorders, repeat surgery >12 weeks after prior decompression with prior symptomatic relief (unless post‑op imaging shows persistent compression), and urgent/emergent indications (CES, progressive deficit, infection, hematoma, unstable fracture, tumor, etc.) may bypass conservative-treatment requirements but still need confirmatory imaging and documentation.