CMM-605: Cervical Microdiscectomy

CMM‑605 deems cervical microdiscectomy medically necessary for urgent/emergent presentations (e.g., myelopathy/cord signal change, central cord syndrome, progressive neurologic deficit, significant motor weakness, bowel/bladder dysfunction, or incapacitating pain) and for initial primary or repeat procedures when strict criteria are met, and specifically excludes surgery for isolated annular tears, disc bulge without neural impingement, degenerative disc disease, non‑concordant signs/symptoms, discography, or MR spectroscopy alone. Key requirements include recent (≤6 months) concordant MRI/CT (post‑op imaging showing recurrent compression for repeats), specified subjective and objective neurologic findings, failure of ≥2 conservative therapies for radiculopathy unless urgent, absence of unmanaged significant mental/behavioral health disorders (unless urgent), and for repeats >12 weeks since the prior procedure with documented initial symptom relief.

"Requests for individuals with atypical symptoms or clinical presentations that are not specifically addressed will require physician review."