CMM-605: Cervical Microdiscectomy

Cervical microdiscectomy is covered for initial and repeat treatment of radiculopathy or myelopathy only when specified subjective symptoms and concordant objective findings are documented, recent (≤6 months) MRI/CT confirms neural compression, radiculopathy cases have failed ≥2 conservative measures (~6 weeks each) unless contraindicated, repeat procedures are >12 weeks post‑op with prior symptom relief and post‑op imaging confirming recurrent compression, and non‑urgent cases show absence of unmanaged significant mental/behavioral health disorders. Procedures not meeting criteria—including isolated annular tear, disc bulge without neural impingement, degenerative disc disease, or symptoms not correlated with imaging—are not medically necessary, while urgent/emergent indications (e.g., progressive myelopathy, cord compression, rapidly worsening weakness, bowel/bladder dysfunction) may proceed promptly with confirmatory advanced imaging without the conservative or behavioral‑health prerequisites.