CMM-601: Anterior Cervical Discectomy and Fusion

ACDF is covered for urgent/emergent cervical instability/neurologic compromise and for initial primary, repeat, adjacent-segment, or arthroplasty-failure indications when clinical findings are concordant with radiculopathy or myelopathy; it is not medically necessary for chronic non‑specific neck/arm pain or degenerative disc disease without radiculopathy/myelopathy. Key requirements for elective cases include recent concordant imaging (plain cervical x‑rays and MRI/CT within 6 months), documented failure of specified conservative therapies (typically ≥2 trials where indicated), nicotine‑free status (cotinine ≤10 ng/mL or never‑smoker), absence of unmanaged significant behavioral/mental health disorders, and appropriate timing since prior procedures (with some elective requirements waived for confirmed urgent/emergent cases).

"Not medically necessary for cervical degenerative disc disease without radiculopathy or myelopathy."