Spinal Fusion and Decompression – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers cervical/thoracic/lumbar decompression and fusion (including scoliosis/kyphosis surgery) when medical necessity per InterQual CP is met — e.g., arthrodesis for instability/cord compression/fracture/tumor/infection, surgery for symptomatic lumbar spinal stenosis, and spondylolysis/spondylolisthesis with progressive deficit/cauda equina or persistent severe pain — and explicitly excludes isolated facet fusion, dynamic stabilization for degenerative spondylolisthesis, total facet arthroplasty, and staging multiple sessions when one session would suffice as unproven/not medically necessary. Key requirements include documentation of failed conservative therapy, validated pain/function scores (e.g., ODI >8 or specified SF‑36 thresholds), specific neurologic exam findings and imaging correlation (including flexion/extension showing ≥3 mm displacement or >11° angulation for spondylolisthesis), and adherence to the applicable InterQual CP; coverage remains subject to the member’s benefit plan and applicable laws.