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    v1.0.30
    OpenPayerPolicy UpdatesPain ManagementArizona Complete Health Discography Coverage | Ope…
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    CurrentArizona Complete HealthPolicy CP.MP.115

    Discography (PDF)

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    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
    Last ReviewMay 24, 2024
    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.

    OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

    1Policy Position: Lumbar
    1Policy Position: Cervical/Thoracic
    5Referenced CPT Codes

    Coverage Summary

    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
    62290Injection procedure for discography, each level; lumbar.
    62291Injection procedure for discography, each level; cervical or thoracic.
    62292Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar.
    72285Discography, cervical or thoracic, radiological supervision and interpretation.
    72295Discography, 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

    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.

    SourceSummary
    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

    Added clarifying language to Criteria I.

    06/21revised

    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.'

    07/16split

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

    Policy Summary
    PayerArizona Complete Health
    PolicyDiscography (PDF)
    Policy CodePolicy CP.MP.115
    Change TypeClarified / Revised / Split
    Effective Date
    Last ReviewMay 24, 2024
    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
    On This Page
    Coverage SummaryMedical Necessity DeterminationsNot Covered / Insufficient EvidenceRelevant CodesProvider Actions & Billing ImpactBackground & EvidenceRevision History
    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