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OPD Procedure: Cervical Fusion with Disc Removal

This surgical procedure may relieve spinal cord or nerve root pressure and alleviate corresponding pain, weakness, and tingling. The procedure is accompanied by a fusion surgery to stabilize the spine.

Medical Necessity

Services are considered reasonable and medically necessary in patients experiencing one or more of the following:

  • Indications for cervical fusion may include but is not limited to:
    • Neurological dysfunction in the presence of spinal cord compression
    • Cervical instability
    • Cervical spinal stenosis (myelopathy)
    • Fractures/trauma
    • Spinal deformities
    • Emergency situations/indications that do not require conservative therapy
      • Progressive neurological compromise/deficits
      • Unstable spinal fracture/dislocations
      • Progressive/clinically significant spinal deformity
  • Persistent debilitating pain daily
  • Neck pain with associated symptoms such as numbness, tingling, and weakness
  • Failure to respond to conservative therapy such as exercise plan, pharmacological, PT/OT therapy, etc.

General Documentation Requirements

  • Clinical evaluations related to the patient’s pain
  • Current H&P, office visit notes or physician progress notes
  • Radiological imaging studies (CT, MRI, X-ray) confirming diagnosis/diagnoses and validated by a physician
  • Documentation related to previous conservative treatments tried
  • Documentation on how their pain affects their ADLs
  • For emergency situations/ indications that do not require conservative therapy
    • Radiological imaging studies
    • Physical findings and imaging studies correlate

Prior Auth Request Form

Prior Authorization OPD: Cervical Fusion with Disc RemovalPDF

Coverage Criteria and Resources


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