Cervical Spinal Fusion

This policy covers cervical spinal fusion procedures for conditions such as cervical nerve root compression with imaging and objective neurologic correlation, progressive or severe myelopathy/cord compression, unremitting radicular pain refractory to ≥6 weeks of conservative care, degenerative cervical kyphosis meeting criteria, unstable fractures/dislocations, infection, tumor, symptomatic pseudarthrosis, atlantoaxial instability, and revision for implant failure after cervical disc arthroplasty. Coverage requires objective imaging correlation and, for non‑emergent cases, a trial of conservative management unless waived for progressive neurologic deficits or myelopathy; benefits are governed by the member’s plan, limited to the index level after prior disc arthroplasty, and subject to additional exclusions and limitations.

"Cervical fusion for cervical nerve root compression when imaging demonstrates nerve root compression due to a herniated disc or spondylotic osteophyte that correlates with the distribution of signs..."