Discography
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Defines medical necessity and coverage stance for lumbar, cervical, and thoracic discography for members of Ambetter Nevada (Centene-affiliated health plans). Applies to providers ordering or performing discography.
No material clinical or coverage changes in this revision.
Coverage criteria for discography
Lumbar Discography — Not Medically Necessary
Policy statement I: not medically necessary
Cervical/Thoracic Discography — Insufficient Evidence
Policy statement II: insufficient evidence
For cervical and thoracic pain, discography is not an appropriate diagnostic or screening tool. The literature lacks validation and controlled outcome studies for cervical and thoracic discography, with few and low-quality studies available, and therefore the procedure is not supported as a diagnostic or screening modality in these regions.
Lumbar discography is considered not medically necessary. The policy states that there is evidence the procedure is not safe or effective for lumbar indications, and claims for lumbar discography may be denied on that basis.
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 |
Provider requirements, documentation, and billing notes
Prior Authorization Required
Prior authorization is required for the listed CPT codes for discography prior to scheduling or performing the service. Submit a PA request with clinical documentation supporting the medical necessity of the procedure. Failure to obtain prior authorization may result in claim denial or delayed payment.
Documentation and Coding
Document the clinical indication, targeted disc level(s), prior noninvasive diagnostic workup (including relevant imaging), and rationale linking discography results to an expected change in management. Include procedural details such as levels tested, contrast used, and injection pressures, and attach relevant imaging reports (MRI, CT) when available.
Denial Risk — Lumbar Discography
Be aware that claims for lumbar discography may be denied as not medically necessary in accordance with policy statement I (lumbar discography is considered not medically necessary). Review policy criteria and consider alternative diagnostic approaches before ordering.
Provider Action — Operational Reminder
Providers should note operational steps that impact billing and authorization: ensure prior authorization is requested for the CPT codes above, include all required documentation at time of PA submission, and verify member eligibility and benefits. If prior authorization is not approved, do not perform the procedure expecting coverage.
- Verify member eligibility and PA response before scheduling.
- Include clinical notes and imaging with PA to reduce denial risk.
Prior conservative care and exclusion of other causes
Imaging prerequisites
Imaging requirement — exclude confirmed sources on prior imaging
Before ordering discography, ensure other imaging has not already identified the source of discogenic pain; discography is intended only when other imaging has not confirmed the pain source.
- Policy history: added language that other imaging must not have confirmed source of discogenic pain
- Discography is considered after other possible sources of lumbar pain have been excluded
Key definitions
Background
Discography is an invasive intradiscal diagnostic test performed to reproduce a patient’s pain and visualize disc morphology by injecting contrast into the intervertebral disc under imaging guidance. It is intended to help determine whether a symptomatic disc is the source of pain when surgery is being considered, but the procedure is controversial due to mixed evidence on diagnostic accuracy and concerns about safety and potential to accelerate disc degeneration.
Not covered / excluded services
Lumbar discography is not covered and is considered not medically necessary under this policy. Providers should be aware that services billed for lumbar discography may be subject to denial as not medically necessary per policy statement I.
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