CMM-613: Thoracic Decompression and Discectomy

eviCore covers initial and repeat thoracic decompression/discectomy only when all criteria are met — elective cases require exclusion of other pain sources and unmanaged behavioral health disorders, concordant MRI/CT within 6 months, and specific subjective and objective findings for radiculopathy (including failure of at least two 6‑week conservative therapies unless contraindicated) or myelopathy; repeat surgery additionally requires >12 weeks since the prior procedure, documented initial symptomatic relief, and post‑op MRI/CT showing recurrent neural compression. Procedures are excluded/not medically necessary if symptoms do not correlate with imaging (e.g., annular tears, non‑impinging disc bulge, degenerative disc disease alone), and listed percutaneous/laser/minimally invasive thoracic discectomy techniques are investigational; urgent/emergent neurologic indications may waive some elective requirements but still require confirmatory imaging.

"For elective initial procedures: recent (within 6 months) MRI/CT that is concordant with the patient's symptoms and physical examination findings (for radiculopathy: MRI/CT identifies nerve root im..."