CMM-610: Lumbar Total Disc Arthroplasty

Covered: initial primary single‑level lumbar total disc arthroplasty is medically necessary only for FDA‑approved devices used at L4‑5 or L5‑S1 and is excluded for revisions, multi‑level/hybrid or partial prostheses, procedures outside FDA labeling, patients <18 or >60, osteoporosis/osteopenia (T‑score < −1.0), spondylolisthesis >3 mm, spinal stenosis, pars defects, scoliosis >11°, infection, tumor, nerve‑root compression, facet ankylosis/severe facet degeneration, inadequate disc height or endplate dimensions, and other listed contraindications. Key requirements: age 18–60, ≥1 year of chronic discogenic axial low‑back pain with severe daily pain (VAS/NRS ≥7) and functional impairment, failure of ≥6 months structured physician‑supervised multimodal nonoperative care (including prescription analgesics/steroids/NSAIDs AND a provider‑directed exercise program), recent imaging (≤6 months) confirming single‑level degeneration and absence of contraindicating findings, acceptable bone density and specific preoperative measurements, and complete documentation per FDA labeling.