CMM-610: Lumbar Total Disc Arthroplasty Guidelines

Covered only for initial primary single‑level lumbar TDA at L3‑4, L4‑5, or L5‑S1 in patients 18–60 using an FDA‑approved device; excluded for revisions, hybrid or multi‑level implants, implants outside FDA‑approved segments, osteoporosis/osteopenia (T‑score < -1.0), facet ankylosis/severe facet degeneration, significant spondylolisthesis, spinal stenosis, deformity, infection, autoimmune disease, implant allergy, and other listed exclusionary conditions. Key requirements: recent (≤6 months) X‑ray plus CT/MRI confirming moderate‑to‑severe single‑level degeneration with adequate disc height (≥3 mm) and mid‑sagittal canal (≥8 mm), documented severe daily discogenic pain (VAS/NRS ≥7 or disabling ≥1 year) with functional impairment, failure of structured physician‑supervised multimodal conservative care for ≥6 consecutive months, absence of unmanaged significant mental/behavioral disorders, appropriate bone density and implant sizing documentation, and prior authorization per CMM‑600.1.