CMM-608: Lumbar Decompression

Covered: initial and repeat lumbar decompression are medically necessary for neurogenic claudication or spondylolisthesis-related radicular pain when advanced imaging shows nerve root/thecal sac compression concordant with exam and symptoms; excluded are procedures for sole indications (annular tear, isolated disc bulge without neural impingement, concordant discography, MR spectroscopy, degenerative disc disease) and percutaneous/laser discectomy, MILD®, and all interspinous/interlaminar spacer or stabilization devices (considered experimental/investigational). Key requirements: recent (≤6 months) MRI/CT concordant with findings, documentation of at least two failed conservative treatments (unless urgent/emergent such as CES, infection, fracture, hematoma, progressive neurologic deficit, which still require confirmatory imaging), exclusion of other pain sources, absence of unmanaged significant mental/behavioral health disorders, and for repeat surgery >12 weeks since prior decompression with post‑op imaging showing compression and prior symptomatic relief (unless imaging shows persistent compression).