Interspinous Fusion and Decompression Devices – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers interspinous fixation (fusion) devices only when used with an interbody cage as an adjunct to single-level (L1–S1) interbody fusion for discogenic back pain with degeneration confirmed by history and radiographic studies and with no greater than Grade 1 spondylolisthesis, while interspinous decompression and interlaminar stabilization devices used without fusion are unproven and not medically necessary. Coverage requires documentation of disc degeneration, device use with an interbody cage at a single L1–S1 level, spondylolisthesis grade ≤1, and adherence to FDA labeled indications/contraindications/warnings/precautions.

"Interspinous fixation (fusion) devices are proven and medically necessary when performed according to U."

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