CMM-614: Thoracic and Thoracolumbar Fusion

Covers thoracic/thoracolumbar fusion (with or without decompression) when specific diagnoses/metrics are met (pediatric/adolescent/congenital/neuromuscular/infantile scoliosis, urgent/emergent infection/neoplasm/trauma, adult degenerative/residual deformity with thresholds such as Cobb >30° for degenerative or >50° for idiopathic/residual, SVA >8 cm or PI‑LL >15°, documented/anticipated iatrogenic or dynamic instability, adjacent‑segment/proximal junctional failure, and certain repeat fusions) and excludes procedures when the sole indication is multilevel degenerative disc disease, isolated facet disease, initial discectomy/laminectomy or fusion only as an adjunct to decompression without instability, as well as several experimental/investigational techniques/devices (e.g., percutaneous indirect fusion, non‑FDA implants, disc annular repair, endoscopic fusion, isolated facet fusion, total facet arthroplasty). Coverage requires confirmatory imaging documenting the metric/instability criteria, documented failure of required conservative treatments (usually ≥2 modalities for ≥6 weeks with decompression or ≥3 months for fusion without decompression unless contraindicated), evidence of nicotine‑free status (cotinine ≤10 ng/mL), absence of untreated significant behavioral/mental health conditions, and compliance with specific documentation/timing rules for anticipated instability and repeat fusion (>6 months unless implant failure/pseudarthrosis).