Spine Surgery Guidelines

The eviCore Spine Surgery Guidelines cover specified cervical and lumbar surgeries (e.g., ACDF, decompression/discectomy, FDA‑labeled cervical and lumbar TDA, vertebral augmentation, SI‑joint fusion, and certain orthobiologics/bone stimulation when evidence supports) and explicitly exclude many non‑indications and experimental/investigational uses (e.g., degenerative change without radiculopathy/myelopathy, off‑label or multi‑level device use, unproven orthobiologics, and use of discography to determine necessity). Coverage is conditioned on concordant recent imaging (usually ≤6 months), defined subjective and objective neurologic findings, documented failure of specified conservative care (typically ≥2 six‑week trials and sometimes ESIs), nicotine‑free documentation (never‑smoker or cotinine ≤10 ng/mL after ≥6 weeks cessation) for many fusion procedures, adherence to device/procedural limits, precise prior‑authorization documentation, and specified timing rules for reoperations (with urgent/emergent exceptions).