Cervical Fusion

Cervical fusion is covered when clinical symptoms (e.g., radicular arm pain VAS ≥4 for ≥12 weeks or neurologic deficits) correlate with imaging evidence of cervical nerve root or central canal compression and when conservative management has failed, except in defined urgent cases (e.g., progressive neurologic deficit, severe radiculopathy VAS ≥7, loss of bowel/bladder, or myelopathy class III+). Coverage also includes fracture/dislocation with instability or neurologic deficit, tumors causing instability/deficit, spinal infection with vertebral destruction causing instability, deformity with functional limitation or instability, and symptomatic pseudarthrosis ≥12 months post-fusion or with hardware failure. Isolated chronic axial neck pain and asymptomatic myelopathy are not covered; required documentation includes imaging, clinical-radiologic correlation, objective pain scores, failure of conservative therapy, measurements of instability, infection proof when applicable, and provider credentialing.