Spine Surgery Guidelines

This eviCore guideline covers a broad range of spine surgeries (ACDF, cervical/lumbar decompression and fusion, microdiscectomy, vertebral augmentation, SIJ fusion, repeat/failed‑implant procedures, etc.) and explicitly excludes many non‑indications and investigational uses (chronic non‑specific neck/arm pain, degenerative disc disease without radiculopathy/myelopathy, many TDA scenarios, electrical/ultrasound stimulation, experimental grafts/devices). Key requirements include prior authorization for elective cases (≥2 weeks), recent concordant imaging (typically within 6 months with independent reads and flexion/extension x‑rays for fusions), specified subjective/objective radiculopathy or myelopathy criteria, documented failure of defined conservative treatments (or documented contraindication), and evidence of nicotine‑free status (never‑smoker or cotinine ≤10 ng/mL after ≥6 weeks), with urgent/emergent exceptions.

"Prior-authorization requests should be submitted at least two weeks prior to the anticipated date of an elective spinal surgery. (CMM-600."