Total Artificial Disc Replacement for the Spine – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers cervical TDR with an FDA‑approved prosthesis for one or two contiguous levels (C3–C7) in skeletally mature patients with symptomatic radiculopathy and/or myelopathy (including prior fusion at another level) and covers single‑level lumbar TDR for skeletally mature patients with symptomatic, intractable discogenic low back pain; lumbar TDR at >1 level, cervical TDR performed with fusion in the same surgical plan, hybrid constructs, and other NASS‑listed exclusions (e.g., multi‑level disease, significant facet arthropathy, spondylolisthesis >Grade I, age >60 or <18, osteopenia, infection/tumor) are considered unproven/not medically necessary. Coverage requires an FDA‑approved device, member‑specific benefit review, documentation (medical records, radiographic proof of skeletal maturity) and meeting InterQual® medical necessity criteria, and does not guarantee payment.

"For medical necessity clinical coverage criteria, refer to the InterQual® CP: Procedures, Artificial Disc Replacement, Cervical (and for lumbar: InterQual® Client Defined, CP: Procedures, Artificia..."