Spinal Fusion Surgery - Medicare Advantage

This policy addresses coverage of spinal fusion surgery (spinal arthrodesis), including cervical, thoracic, lumbar and sacroiliac joint fusions (open and minimally invasive), facetectomy-associated fusions, and related device-specific procedures (e.g., posterior vertebral joint replacement 0719T). It applies to patients with degenerative disc disease, scoliosis/kyphosis, spondylolisthesis, trauma with spinal nerve compression, or vertebral instability from infection/tumor, but coverage, specific indications, and any documentation or limitation requirements are determined by the applicable Medicare Administrative Contractor’s Local Coverage Determination/LCA for the beneficiary’s jurisdiction; the excerpt contains no explicit medical necessity criteria, frequency limits, or age restrictions.

"Spinal fusion performed in conjunction with facetectomy."

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