Cervical Fusion

Cervical fusion is covered when clinical signs/symptoms (commonly arm pain VAS >=4/10 for >=12 weeks) with failed multimodal conservative therapy, functional impairment, exclusion of other causes, and confirmatory MRI/CT findings (stenosis, cord compression, tumor, infection, or instability) correlate at the symptomatic level. Exceptions waive the conservative-therapy requirement for myelopathy (class III+ or progressive deficits), progressive motor weakness, severe radicular pain (VAS >=7/10) with imaging correlation, loss of bowel/bladder, traumatic instability, tumor-related or infection-related instability, deformity with neurologic compromise, and symptomatic pseudarthrosis >=12 months after prior fusion. Documentation must include pain scores, conservative treatment attempts, imaging with clinicoradiologic correlation, objective instability measures (translation >3.5 mm or angulation >11°), and appropriate provider credentials; claims may be audited.