Discography
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This policy defines the medical necessity and coverage stance for lumbar, cervical, and thoracic discography for members of Ambetter Georgia and affiliated Centene health plans.
No material clinical or coverage changes in this revision.
Coverage Determinations
Coverage determinations
Policy statements:
Policy-level determination; no clinical criteria provided to support coverage.
Policy-level determination: insufficient evidence; no coverage criteria provided.
There is insufficient evidence in the published peer‑reviewed literature to support the use of cervical and thoracic discography. The procedures are controversial because of the absence of validation and controlled outcome studies, limited and low‑quality literature, and they are not appropriate diagnostic or screening tools for cervical or thoracic pain.
The policy states that lumbar discography is considered not medically necessary because there is evidence that the procedure is not safe or effective. As a policy‑level determination, no clinical criteria are provided that would support coverage for lumbar discography.
Procedure and Billing Codes
| 62290 | Injection procedure for discography, each level; lumbar |
| 62291 | Injection procedure for discography, each level; cervical or thoracic |
| 62292 | Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar |
| 72285 | Discography, cervical or thoracic, radiological supervision and interpretation |
| 72295 | Discography, lumbar, radiological supervision and interpretation |
| No codes listed |
Provider Guidance and Prior Authorization
Prior authorization & code guidance — expect NMN for lumbar discography
Lumbar discography is considered not medically necessary and cervical/thoracic discography lack sufficient supporting evidence; providers should not expect authorization for lumbar discography and must reference the listed CPT codes if requesting review of any discography procedure (62290, 62291, 62292, 72285, 72295).
Conservative evaluation expected before discography
Discography is described as a controversial diagnostic test to be considered only after other possible sources of lumbar pain have been excluded and when surgery is being considered; providers are expected to have performed other evaluations and imaging before considering discography.
- Other possible sources of lumbar pain should be excluded prior to considering discography
- Discography is used in the context of surgical candidacy evaluation after prior testing
Denial risk — lumbar discography is NMN
Claims for lumbar discography would be denied as not medically necessary based on the policy statement that lumbar discography is considered not medically necessary.
- Do not expect coverage for lumbar discography; submitters should anticipate denial as NMN
Clinical Background
Discography is an invasive, intradiscal diagnostic technique in which contrast medium is injected into an intervertebral disc to reproduce pain and assess disc morphology. It is intended to evaluate for discogenic pain and to help determine surgical candidacy. The test is controversial: proponents cite associations between disc degeneration and symptoms, while critics note inconsistent accuracy, potential to reproduce pain in pain‑free individuals, lack of validation and controlled outcome data, and evidence suggesting the procedure may accelerate disc degeneration.
Key Definitions
Prior Conservative Evaluation Requirements
Other evaluations/imaging should have been performed and other sources excluded prior to considering discography.
Other evaluations and imaging must be performed and alternative sources excluded before considering discography.
Discography is described as a controversial diagnostic test used only after other sources have been considered and when surgery is being contemplated.
Policy revision notes indicate that other imaging should not have confirmed the source of discogenic pain before considering discography.
Imaging Preconditions
Confirm prior imaging did not identify discogenic pain source
Other imaging must not have already confirmed the source of discogenic pain before discography is considered; ensure imaging did not identify the pain source prior to proceeding.
- Document that prior imaging did not confirm the source of discogenic pain
Services Not Covered
Not covered: Lumbar discography is considered not medically necessary and claims for this procedure are not supported under this policy.
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