Cervical Fusion

Cervical fusion is covered when clear clinical signs/symptoms (e.g., radiculopathy or myelopathy with functional impairment), corroborating imaging (MRI/CT) at the corresponding level, and documented failure of multimodal conservative therapy (generally ≥12 weeks, VAS≥4 for radicular pain) are present, or when exceptions apply (progressive neurologic deficits, severe motor weakness, loss of bowel/bladder control, or myelopathy class III+). Fusion is also reasonable for traumatic injuries, tumors, infections, and deformities when instability or neurologic compromise is demonstrated. Isolated axial neck pain and asymptomatic myelopathy are not covered, and all claims must include required imaging, objective neurologic and functional documentation, and appropriate provider credentialing.

"Cervical fusion is reasonable and necessary for decompression of symptomatic cervical nerve root impingement when persistent or recurrent arm pain ≥4/10 on VAS (or equivalent) has been present for ..."