CurrentArizona Complete HealthPolicy CP.MP.115

Discography (PDF)

Defines medical necessity determinations for lumbar, cervical, and thoracic discography for health plans affiliated with Centene Corporation, including policy statements that lumbar discography is not medically necessary and that evidence is insufficient for cervical/thoracic discography. References CPT codes and background evidence.

Policy Summary

PayerArizona Complete Health

PolicyDiscography (PDF)

Policy CodePolicy CP.MP.115

Change TypeClarified / Revised / Split

Effective Date

Next Review Date

Key ActionDo not perform lumbar discography as it is considered not medically necessary by the policy; claims for lumbar discography CPT codes may be denied per policy.

SourceLink

POLICY UPDATE CHANGES

Added clarifying language to Criteria I.

Replaced 'experimental/investigational' verbiage in policy statement II with 'there is insufficient evidence in the published peer-reviewed literature to support the use of cervical and thoracic discography.'

Policy split from CP.MP.63 Pain Management Procedures.

1Policy Position: Lumbar

1Policy Position: Cervical/Thoracic

5Referenced CPT Codes

Policy Number: CP.MP.115; Status: CURRENT. Lumbar discography is considered not medically necessary. Cervical and thoracic discography are determined to have insufficient evidence in the published peer‑reviewed literature to support their use. Last review: 2024-05-24.

Key Facts

Policy NumberCP.MP.115

Policy StatusCURRENT

Last Review Date04/25 (Date of Last Revision)

Scope SummaryDefines medical necessity determinations for lumbar, cervical, and thoracic discography for Centene-affiliated health plans: lumbar discography is considered not medically necessary; there is insufficient evidence to support cervical and thoracic discography. References CPT codes and background evidence.

Medical Necessity Determinations

Policy / Criteria

Lumbar discography determination: Lumbar discography is considered not medically necessary.

Cervical and thoracic discography determination: There is insufficient evidence in the published peer-reviewed literature to support the use of cervical and thoracic discography.

Not Covered / Insufficient Evidence

Policy stance: Lumbar discography is not medically necessary because evidence shows the procedure is not safe or effective. Cervical and thoracic discography are considered to have insufficient evidence to support their use. The policy notes controversies about diagnostic accuracy and reliability, conflicting study results, lack of a gold standard, and potential for harm including accelerated disc degeneration; cervical and thoracic procedures specifically lack validation and controlled outcome studies.

Supporting evidence and safety considerations:

• Guideline/position: The North American Spine Society (NASS) supports use of lumbar discography for associating pain with moderate to severe disc degeneration but indicates insufficient evidence to predict surgical outcomes.

• Safety signal: A prospective cohort study suggests discography may lead to accelerated disk degeneration (new herniations, loss of disc height, and loss of disc signal intensity).

Relevant Codes

Referenced CPT Codes for DiscographyCPT

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 Actions & Billing Impact

Documentation Required

Do not perform lumbar discography

Lumbar discography is considered not medically necessary per the policy. Providers should not perform lumbar discography; claims for the listed lumbar discography CPT codes may be denied under this policy.

62290
62292
72295

Documentation Required

Cervical and thoracic discography investigational/insufficient evidence

There is insufficient evidence in the published peer-reviewed literature to support the use of cervical and thoracic discography. Providers should recognize that use of the cervical and thoracic discography CPT codes may not meet medical necessity criteria under this policy.

62291
72285

Billing Rule

Coding guidance informational

The CPT codes listed are provided for informational purposes only. Inclusion or exclusion of codes does not guarantee coverage; providers should reference up-to-date coding guidance prior to claim submission.

62290
62291
62292
72285
72295

Background & Evidence

Background: Discography is an invasive intradiscal diagnostic technique that injects contrast into a disc to reproduce pain and visualize disc morphology to help determine surgical candidacy. Lumbar discography is controversial with conflicting evidence about accuracy and reliability, absence of a clear gold‑standard reference test, and critics noting the test can provoke pain in persons without prior back pain. Studies disagree on its ability to identify the pain source or guide treatment. There is also evidence suggesting potential harms, including accelerated disc degeneration. Cervical and thoracic discography lack validation and controlled outcome studies, with few and poor‑quality publications, and are not appropriate diagnostic or screening tools for cervical or thoracic pain.

Source	Summary
Guideline/Position (NASS)	NASS supports use of lumbar discography for associating pain with moderate to severe disc degeneration and endplate abnormalities on imaging but indicates insufficient evidence that discography predicts successful surgical outcomes.
Safety signal (prospective cohort study)	Evidence from a prospective cohort study suggests discography may lead to accelerated disk degeneration, including new herniations, loss of disc height, and loss of disc signal intensity.

Discography: An invasive, intradiscal diagnostic technique using contrast injection and pain provocation to diagnose discogenic pain.

Revision History

04/25clarified