Spine Surgery Guidelines

eviCore covers specific cervical and lumbar surgical procedures (e.g., ACDF, select single‑level cervical total disc arthroplasty in 18–60 y/o, posterior decompression/fusion, microdiscectomy), vertebral augmentation, SI‑joint fusion, and limited use of rhBMP‑2/BMAC while deeming numerous techniques investigational or not medically necessary (discography is not endorsed; many arthroplasty and stimulation uses excluded). Coverage requires prior authorization (generally ≥2 weeks for elective), concordant recent imaging within specified timeframes, detailed documentation of failed conservative care per procedure (typical timelines 6 weeks–6 months), nicotine‑free verification (nonsmoker or cotinine ≤10 ng/mL after ≥6 weeks abstinence), and absence of unmanaged behavioral health disorders plus other procedure‑specific objective criteria.

"For lumbar TDA: documentation of absence of unmanaged significant behavioral health disorders."