Spine Surgery Guidelines

eviCore covers specific cervical and lumbar spine surgeries (e.g., ACDF, cervical/lumbar disc arthroplasty, decompression/fusion, microdiscectomy, vertebral augmentation, SI‑joint fusion, orthobiologics) only when strict medical‑necessity criteria are met and excludes non‑indicated or experimental uses (e.g., chronic non‑specific neck pain, many device/age/bone‑disease scenarios, and other listed contraindications). Key prior‑authorization requirements include detailed documentation of recent concordant advanced imaging (generally ≤6 months, sometimes ≤3 months), objective neurologic findings, failure of or contraindication to specified conservative treatments, absence of unmanaged behavioral‑health disorders, nicotine‑free status with cotinine verification for many procedures, and adherence to procedure‑specific limits.

"CMM-610."

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