CMM-604: Posterior Cervical Decompression (Laminectomy/Hemilaminectomy/Laminoplasty) with or without Fusion

Posterior cervical decompression (laminectomy/hemilaminectomy/laminoplasty), with or without posterior fusion, is covered when urgent/emergent criteria or defined indications for radiculopathy, myelopathy, tumor-related compression, instability, pseudarthrosis/failed arthroplasty, or other listed conditions are met, and is not medically necessary for presentations that do not meet those criteria (e.g., signs without concordant imaging, annular tears, disc bulge without neural impingement, isolated facet fusion, or procedures not meeting guideline requirements). Key requirements include recent (generally ≤6 months) MRI/CT concordant with symptoms and flexion/extension x‑rays when indicated, required conservative therapy for non‑urgent radiculopathy (≥2 prescription analgesics/steroids/NSAIDs and a 6‑week provider‑directed exercise program ± epidural steroid unless contraindicated), nicotine‑free documentation (cotinine ≤10 ng/mL or never‑smoker) for fusion, absence of unmanaged significant mental/behavioral health disorders, specified timing since prior surgeries, and prior authorization per CMM‑600.1 where applicable.