Artificial Intervertebral Disc Replacement
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1 Medical Coverage Policy Page: 1 of 8 Change Summary: Updated Disclaimer, Background, Provider Claims Codes, Medical Terms, References Disclaimer Description Coverage Determination Background Medical Alternatives Provider Claims Codes Medical Terms References Disclaimer Description State and federal law, as well as contract language, including definitions and specific inclusions/ exclusions, take precedence over clinical policy and must be considered first in determining eligibility for coverage. Coverage may also differ for our Medicare and/or Medicaid members based on any applicable Centers for Medicare & Medicaid Services (CMS) coverage statements including National Coverage Determinations (NCD), Local Medical Review Policies (LMRP), and/or Local Coverage Determinations. See the CMS web site at The member's health plan benefits, in effect on the date services are rendered, must be used. Clinical policy is not intended to preempt the judgment of the reviewing Medical Director or dictate to providers how to practice medicine. Providers are expected to exercise their medical judgment in rendering the most appropriate care. Identification of selected brand names of devices, tests, and procedures in a Medical Coverage Policy are for reference only and is not an endorsement of any one device, test or procedure over another. Clinical technology is constantly evolving, and we reserve the right to review and update this policy periodically. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any shape or form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from Humana Inc. Artificial intervertebral disc replacement was designed as an alternative to cervical and lumbar spinal fusion surgery for those patients suffering from back or neck pain due to degenerative disc disease (DDD). The artificial disc was designed to restore normal disc height, to preserve the spinal flexibility as well as decrease degeneration of adjacent discs, which can occur as a result of DDD. Examples of Food and Drug Administration (FDA) approved artificial discs for the lumbar spine include, but may not be limited to, the Charité Artificial Disc and the ProDisc L Total Disc Replacement. Those FDA approved for the cervical spine include, but may not be limited to, the Prestige Cervical Disc, the ProDisc C Total Disc Replacement, and the BRYAN Cervical Disc.
2 Page: 2 of 8 Coverage Determination Humana members may NOT be eligible under the Plan for artificial intervertebral disc replacement for the cervical or lumbar spine. This technology is considered experimental/investigational as it is not identified as widely used and generally accepted for the proposed use as reported in nationally recognized peer reviewed medical literature published in the English language. Background You can learn more about degenerative disc disease (DDD) from the following sites: American Academy of Orthopedic Surgeons (AAOS) National Library of Medicine Medical Alternatives Alternatives to artificial intervertebral disc replacement for the cervical or lumbar spine include, but may not be limited to, the following: Acupuncture (Please refer to the Acupuncture Medical Coverage Policy) Bracing (Please refer to the Orthotics Medical Coverage Policy) Cervical or lumbar fusion (Please refer to the Spinal Fusion Surgery Medical Coverage Policy) Exercise Physical therapy (Please refer to the Physical Therapy (PT) and Occupational Therapy (OT) Medical Coverage Policy) Prescription drug therapy may be appropriate for this condition Spinal Decompression Surgery (Please refer to the Spinal Decompression Surgery Medical Coverage Policy)
3 Page: 3 of 8 To make the best health decision for your individual needs, consult your physician. Provider Claims Codes All provider claims codes surrounding this topic may not be included in the following table: CPT Code(s) Description Comments Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and micro dissection), single interspace, cervical Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace, lumbar Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar CPT Category III Codes Description Comments 0092T 0095T Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and micro dissection), each additional interspace, cervical (List separately in addition to code for primary procedure) Removal of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (List
4 Page: 4 of T 0163T 0164T 0165T separately in addition to code for primary procedure) Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (List separately in addition to code for primary procedure) Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), each additional interspace, lumbar (List separately in addition to code for primary procedure) Removal of total disc arthroplasty, (artificial disc), anterior approach, each additional interspace, lumbar (List separately in addition to code for primary procedure) Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, lumbar (List separately in addition to code for primary procedure) HCPCS Code(s) Description Comments No code(s) identified ICD 9 Procedure Code(s) Description Comments Insertion of spinal disc prosthesis, not otherwise specified Insertion of partial spinal disc prosthesis, cervical Insertion of total spinal disc prosthesis, cervical Insertion of spinal disc prosthesis, thoracic Insertion of partial spinal disc prosthesis, lumbosacral Insertion of total spinal disc prosthesis, lumbosacral Revision or replacement of artificial spinal disc prosthesis, cervical Revision or replacement of artificial spinal disc prosthesis, thoracic
5 Page: 5 of Revision or replacement of artificial spinal disc prosthesis, lumbosacral Revision or replacement of artificial spinal prosthesis, not otherwise specified Medical Terms Acupuncture a Chinese medical practice or procedure that treats illness or provides local anesthesia by the insertion of needles at specified sites of the body. Adjacent Next to or adjoining. Cervical Relating to or associated with the neck. Compression Increasing physical pressure on a vital structure. Degeneration Gradual deterioration of specific tissues, cells, or organs with corresponding impairment or loss of function, caused by injury, disease or aging. Deterioration To diminish or impair in quality, character or value. Flexibility To be capable of being bent repeatedly without injury or damage. Lumbar Of, near, or situated in the part of the back and sides between the lowest ribs and the pelvis. Spinal Fusion Procedure that involves the joining together of two or more vertebrae in the spine using either bone grafts or metal rods. References American Academy of Orthopedic Surgeons (AAOS) Website. AAOS now. Fusion leads to more adjacent segment disease than arthroplasty. July Available at: Accessed December 6, American Academy of Orthopedic Surgeons (AAOS) Website. OrthoInfo. Cervical radiculopathy: surgical treatment options. February Available at: Accessed December 6, 2011.
6 Page: 6 of 8 American Academy of Orthopedic Surgeons (AAOS) Website. OrthoInfo. Artificial disk replacement in the lumbar spine. March Available at: Accessed December 6, American College of Physicians (ACP) Website. Clinical guidelines. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. October 2, Available at: Accessed December 7, American Pain Society (APS) Website. Guideline for the evaluation and management of low back pain evidence review. May 13, Available at: Accessed December 9, Blue Cross Blue Shield Association Website. Technology Evaluation Center (TEC). Artificial intervertebral disc arthroplasty for treatment of degenerative disc disease of the cervical spine. August Available at: Accessed December 9, California Technology Assessment Forum (CTAF) Website. Artificial disc replacement for degenerative disc disease of the cervical spine. October 28, Available at: Accessed December 7, California Technology Assessment Forum (CTAF) Website. Artificial disc replacement for degenerative disc disease of the lumbar spine. February 28, Available at: Accessed December 7, Centers for Medicare & Medicaid Services (CMS) Website. National coverage determination (NCD) for lumbar artificial disc replacement (LADR) (150.10). August 14, Available at: Accessed December 10, ECRI Institute. Health Technology Forecast. Artificial intervertebral disc replacement for lumbar degenerative disc disease. April 6, Available at: Accessed November 30, ECRI Institute. Health Technology Forecast. Artificial intervertebral disc replacement
7 Page: 7 of 8 for cervical degenerative disc disease. July 2, Available at: Accessed November 30, Food and Drug Administration (FDA) Website. Summary and effectiveness data: CHARITE artificial disc. Available at: Accessed December 7, Food and Drug Administration (FDA) Website. Summary and effectiveness data: ProDisc C total disc replacement. Available at: Accessed December 7, Food and Drug Administration (FDA) Website. Summary and effectiveness data: ProDisc L total disc replacement. Available at: Accessed December 7, Hayes, Winifred S. Directory Report. Artificial disc replacement for cervical degenerative disc disease. June 20, Available at: Accessed November 30, Hayes, Winifred S. Directory Report. Lumbar total disc replacement for degenerative disc disease. April 18, Available at: Accessed November 30, Milliman Care Guidelines 15 th Edition. Disk arthroplasty. Available at: careweb.htm. Accessed December 2, National Institute for Health and Clinical Excellence (NICE) Website. Prosthetic intervertebral disc replacement in the cervical spine. May 19, Available at: Accessed April 9, November 30, National Institute for Health and Clinical Excellence (NICE) Website. Prosthetic intervertebral disc replacement in the lumbar spine. July 22, Available at: Accessed April 9, November 30, National Institute of Neurological Disorders and Stroke (NINDS) Website. Low back pain fact sheet. Available at: Accessed December 6, 2011.
8 Page: 8 of 8 North American Spine Society (NASS) Website. Evidence based clinical guidelines for multidisciplinary spine care Available at: Accessed December 9, UpToDate Website. Subacute and chronic low back pain: surgical treatment. September 22, Available at: Accessed December 2, UpToDate Website. Treatment of cervical radiculopathy. September Available at: Accessed December 2, 2011.
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