Cervical Fusion

Cervical fusion is covered for decompression or stabilization when there is clinical-radiologic correlation demonstrating radiculopathy, myelopathy, canal stenosis, instability, trauma, tumor, infection, deformity, or symptomatic pseudarthrosis and when specific severity, duration (commonly ≥12 weeks for radicular pain), imaging, and conservative therapy requirements (or defined exceptions) are met. Surgeries for isolated axial neck pain or asymptomatic myelopathy are not covered, and documentation must include appropriate imaging, clinical findings (pain scores, ADL impact), failed conservative treatment or applicable exceptions, and provider credentialing.

"Cervical fusion is reasonable and necessary for decompression of symptomatic cervical nerve root impingement when persistent or recurrent moderate or severe arm pain (VAS ≥4) is present for ≥12 wee..."

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