Spinal Decompression Surgery - Medicare Advantage

This Medicare Advantage policy covers spinal decompression surgery — including discectomy, corpectomy, facetectomy, foraminotomy/foraminectomy, laminectomy/laminotomy, spinal fusion and percutaneous image‑guided procedures — to relieve spinal cord and/or nerve‑root compression for conditions such as lumbar herniated/ruptured discs, lumbar spinal stenosis, trauma, infection, tumors, ossification of the posterior longitudinal ligament (when treated anteriorly), large osteophytes and other imaging‑confirmed causes of neural compression. Coverage is limited to services deemed medically reasonable and necessary, is subject to Medicare NCD criteria when applicable (eg, NCD 150.13 for PILD/MILD and related G0276/0274T/0275T coding), depends on the location/cause of compression, generally excludes asymptomatic herniations, and may be modified by member benefit documents or medical director review.

"Procedures that may be used to accomplish decompression, including discectomy, corpectomy, facetectomy, foraminectomy, foraminotomy, laminectomy, laminotomy, spinal fusion, or a combination of thes..."