Cervical Fusion

Cervical fusion is covered when objective clinical deficits and imaging correlate to cervical nerve root or canal compression and conservative multimodal therapy has failed (generally after ≥12 weeks), or when exceptions apply such as progressive neurologic deficits, significant myelopathy, severe radicular pain (VAS ≥7), or loss of bowel/bladder function. Imaging (MRI/CT or radiographs) demonstrating stenosis, cord compression, tumor, infection, deformity, or spinal instability (translation >3.5 mm or angulation >11°) and documentation of clinical-radiological correlation, prior therapies, and provider credentials are required. Isolated chronic axial neck pain and asymptomatic myelopathy are not covered, and fusion for any diagnosis must meet all listed criteria to be reasonable and necessary.

"Cervical fusion is reasonable and necessary to decompress symptomatic cervical nerve root impingement when persistent or recurrent moderate or severe radicular arm pain (VAS >=4 or equivalent) has ..."