Cervical Fusion

Cervical fusion is covered when clearly documented cervical radiculopathy, canal stenosis, trauma, tumor, infection, or deformity causes neurologic deficit or instability and when clinical findings, pain severity/duration, failed multimodal conservative care (when required), and correlating MRI/CT or radiographic evidence (including instability thresholds: translation >3.5 mm or angulation >11°) are present. Exceptions permit earlier surgery for significant myelopathy (class III+), progressive neurological deficits, severe radicular pain (VAS ≥7), or loss of bowel/bladder function. Isolated chronic axial neck pain and asymptomatic myelopathy are not covered, and providers must be appropriately credentialed with complete documentation for medical review.

"Cervical fusion for decompression of symptomatic cervical nerve root impingement when persistent or recurrent moderate or severe arm pain (VAS ≥4 or equivalent) has been present for ≥12 weeks withi..."