CMM-604: Posterior Cervical Decompression (Laminectomy/Hemilaminectomy/Laminoplasty) with or without Fusion

Posterior cervical decompression (laminectomy/hemilaminectomy/laminoplasty) with or without posterior fusion is covered for urgent/emergent neural compromise or for radiculopathy, myelopathy, or symptomatic instability when concordant imaging and exam criteria are met; it is not medically necessary for isolated imaging findings without clinical correlation (e.g., annular tear, disc bulge without neural impingement), degenerative disc disease alone, or isolated facet fusion/stand‑alone stabilization devices. Key requirements include recent (≤6 months) cervical X‑rays including flexion/extension and MRI/CT concordant with symptoms, failure of ≥2 conservative therapies for radiculopathy, documented nicotine‑free status (cotinine ≤10 ng/mL or never‑smoker), absence of unmanaged significant mental/behavioral health disorders, and specific radiographic instability thresholds for fusion (with some requirements waived for urgent/emergent cases).

"Urgent/emergent indications/conditions warrant definitive surgical treatment (confirmatory advanced imaging studies are required). Urgent/emergent conditions for posterior cervical decompression wi..."