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CurrentBluecross IdahoPolicy 7.01.646

Discectomy (lumbar and cervical)

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This policy describes Bluecross Idaho coverage criteria for lumbar and cervical discectomy (including endoscopic approaches) for treatment of herniated intervertebral discs and states when discectomy and related technologies are considered medically necessary, not medically necessary, or investigational for members covered under Blue Cross of Idaho benefit plans.

Policy Summary

PayerBluecross Idaho

PolicyDiscectomy (lumbar and cervical)

Policy CodePolicy 7.01.646

Change TypeNo material change

Effective DateJun 25, 2026

Last ReviewJun 25, 2026

Next Review DateJun 25, 2026

Key ActionDocument at least 6 weeks of conservative nonsurgical therapy or justify earlier surgery for rapidly progressive neurologic deficits when requesting prior authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6 weeksConservative care prior to elective discectomy

VAS >4Persistent debilitating pain threshold

6 monthsRequired imaging recency

Apr 24, 2026Most recent literature update

2021Document revision history since

Coverage Criteria for Discectomy

inv-03: Not medically necessary — top-level exclusion node

Not medically necessary: Discectomy (lumbar or cervical) when the criteria above are not met.

Claims may be denied when signs/symptoms, corresponding imaging, or conservative therapy requirements are not documented.

inv-04: Investigational / Unproven — top-level node

Investigational: Discectomy for indications other than lumbar or cervical herniated disc, use of annular closure devices following discectomy, and specified alternative discectomy or intradiscal procedures (e.g., laser discectomy, radiofrequency coblation/nucleoplasty, automated percutaneous discectomy, intradiscal electrothermal annuloplasty, chemonucleolysis) are considered investigational.

Related investigational procedures are referenced in other policies and evidence sections.

inv-05: Clinical Indications — Covered when clinical indications are met

Policy Summary

PayerBluecross Idaho

PolicyDiscectomy (lumbar and cervical)

Policy CodePolicy 7.01.646

Change TypeNo material change

Effective DateJun 25, 2026

Last ReviewJun 25, 2026

Next Review DateJun 25, 2026

Key ActionDocument at least 6 weeks of conservative nonsurgical therapy or justify earlier surgery for rapidly progressive neurologic deficits when requesting prior authorization.

SourceLink

On This Page

Covered when clinical indications are met

Indications for discectomy: Patient has intervertebral disc herniation (extrusion) causing nerve compression with symptoms (pain, numbness, weakness) AND either (a) rapidly progressive neurologic deficits or (b) symptoms of radiculopathy refractory to an adequate trial of conservative care.

Conservative care includes analgesics and a prescribed activity program; epidural steroid injections may be second-line. Rapidly progressive deficits are surgical emergencies warranting expedient surgery.

inv-06: Coverage for Discectomy — Covered when ALL of the following are met

Covered when ALL of the following are met

Main criteria

Conservative care elements: Conservative care includes analgesics, activity/exercise programs, physical therapy; epidural steroid injections may be used as second-line.Documented trial duration and interventions (typically ~6 weeks)
Trials varied; document interventions and outcomes.

inv-07: Evidence-derived eligibility elements — coverage-aligned clinical eligibility elements reflected in the evidence (for consideration)

Coverage-aligned clinical eligibility elements reflected in the evidence (for consideration):

Cervical discectomy evidence-aligned element: Patients with cervical herniated disc(s) with radiculopathy that is rapidly progressing or refractory to conservative care; RCTs compared surgery to structured exercise or conservative measures showing short-term benefit but similar long-term outcomes.Refractory or rapidly progressing symptoms; prior conservative care

Derived from small RCTs and systematic reviews.

Lumbar discectomy + annular closure device evidence-aligned element: Trials of bone-anchored annular closure devices enrolled patients who failed >=6 weeks of nonsurgical treatment and had disc height >=5 mm and large annular defects; primary outcomes included reherniation and reoperation reduction.Failed >=6 weeks nonsurgical care; disc height >=5 mm; large annular defect dimensions

Derived from key RCTs (Thomé et al., Cho et al.) and systematic review, which found reduced reherniation/reoperation but limitations due to lack of blinding.

inv-08: Discectomy (lumbar and cervical) coverage — Covered when ALL of the following are met

Covered when ALL of the following are met

Core indications: Symptoms of radiculopathy that are rapidly progressing OR refractory to conservative care.Conservative care ~6 weeks

Supported by RCTs and systematic reviews showing probable short-term benefit.

Objective confirmation: Level-appropriate documentation of nerve root compression on imaging and/or electrodiagnostic testing correlating with clinical findings.MRI or CT myelogram within past 6 months is preferred

Document imaging that corresponds with symptoms and exam findings.

inv-09: Lumbar discectomy with bone-anchored annular closure device — mixed coverage stance; evidence insufficient to determine improved net health outcome

Coverage stance: mixed — evidence insufficient to determine improved net health outcome

Patient selection for annular closure device: Symptomatic lumbar disc herniation with radiculopathy undergoing primary discectomy at single-level L4-5 or L5-S1; posterior disc height >=5 mm; large intraoperative annular defect (4–6 mm tall and 6–10 mm wide).Posterior disc height >=5 mm; annular defect 4–6 mm tall and 6–10 mm wide

ISASS recommendations and RCT eligibility reflected these selection criteria.

Evidence outcomes: Some RCTs and nonrandomized studies report reduced reherniation and reoperation with a bone-anchored annular closure device, but limitations (lack of blinding, study size, follow-up) leave the net health outcome uncertain.

Primary RCT found reduced reherniation/reoperation up to 5 years; post-market studies report low reherniation rates but evidence considered insufficient for unequivocal coverage.

The policy considers the use of an annular closure device following discectomy investigational. Systematic reviews and randomized trials of bone-anchored annular closure devices have reported mixed results (some reduction in reherniation or reoperation in specific trials), but limitations in study design (for example, lack of blinding) and inconsistent findings lead to an overall conclusion that evidence is insufficient to establish improved net health outcomes for this indication.

Several other surgical variations are not treated as equivalent alternatives to standard discectomy within this evidence review because they lack high-quality comparative trials. Examples listed in the policy include laser discectomy, radiofrequency coblation (nucleoplasty), automated percutaneous discectomy, automated endoscopic discectomy, intradiscal electrothermal annuloplasty, intradiscal radiofrequency therapy, vertebral axial decompression, and chemonucleolysis.

Randomized trials and systematic reviews show that discectomy can produce short-term improvements in pain and function compared with conservative care (for example, reduced VAS leg pain at about 6 months), but many trials find no durable differences at 1 year or later. Therefore, surgery may not provide proven long-term benefit over conservative management for all patients, and operative treatment without appropriate indications or documentation of prior conservative care may not be beneficial.

During evidence synthesis, studies with duplicative or overlapping patient populations were excluded from pooled analyses and systematic review summaries to avoid inflating the apparent strength of evidence.

Given the limited number of randomized trials, methodological constraints (for example, lack of blinding), and mixed results across studies, the policy takes a cautionary stance toward the annular closure device. The available data do not consistently demonstrate clear improvement in patient-centered long-term outcomes, and the device is therefore considered investigational or of uncertain net benefit in many clinical contexts.

The presence of a CPT, HCPCS, or ICD code in the policy or Codes table is provided for reference only. Inclusion of a code does not guarantee coverage or reimbursement; final determinations depend on the member's specific benefit plan, applicable legal requirements, and this medical policy.

Discectomy (lumbar or cervical) is not medically necessary when the stated medical necessity criteria are not met. These criteria include presence of radiculopathy or myelopathy on history and exam, imaging evidence of nerve root compression that corresponds to symptoms, and either rapidly progressing neurologic deficits or persistent, debilitating pain refractory to an adequate trial of conservative therapy (typically about 6 weeks).

Other discectomy variations and intradiscal procedures identified in the policy lack high-quality comparative evidence versus standard open or microdiscectomy. Consequently, these alternative techniques are not considered equivalent to standard discectomy based on the current evidence base.

Elective discectomy performed without documentation of an adequate trial of conservative therapies (typically ~6 weeks of nonsurgical management) or without evidence that symptoms are refractory may be inappropriate and could be considered not medically necessary unless there is documentation of rapidly progressive neurologic deficit that warrants earlier surgery.

The reviewed document does not contain explicit additional blanket statements labeled as 'not medically necessary' beyond the criteria already specified; determinations rely on whether the clinical criteria and documentation requirements are satisfied.

Overall, the policy considers the net benefit of adding an annular closure device at the time of discectomy to be uncertain. While some trials report reduced reherniation or reoperation rates, limitations in trial design and inconsistent results mean that the evidence is insufficient to conclude a clear improvement in long-term patient outcomes.

Codes and Coding Guidance

Codes (referenced)mixed

See Codes table

Policy references a Codes table for procedure and billing codes; specific CPT/HCPCS/ICD codes are listed in that table (not present in this partial document).

Document does not list CPT/ICD codes in this sectionmixed

No codes listed

Related policy codes/referencesmixed

MP 7.01.518

Automated Percutaneous and Percutaneous Endoscopic Discectomy (related policy reference)

Procedure CPT/HCPCS codesmixed

62380	Discectomy may be a component of other codes such as spine fusions, but the codes provided here are specific to cervical or lumbar discectomy.
63020	Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or.
63030	Excision of herniated intervertebral disc, 1 interspace, lumbar.
63032	Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; with repair of annular defect by (implantation).
63035	Each additional interspace, cervical or lumbar (List separately in addition to code for primary procedure).
63043	Re-exploration, single interspace; cervical (re-exploration/discectomy codes).
63044	Each additional cervical interspace (List separately).
63057	Transpedicular approach with decompression of spinal cord and/or nerve root(s), single segment; lumbar.
63075	Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace.
63076	Cervical, each additional interspace (List separately in addition to code for primary procedure).

1–10 of 12

1/2

Diagnosis ICD-10-CM code rangesICD-10

ICD-10-CM

M50.00-M50.13; M50.20-M50.23; M50.20-M50.23; M51.05; M51.06; M51.15; M51.16; M51.17; M51.25-M51.27; M51.A0-M51.A5 (ranges for cervical and lumbar disc disorders, radiculopathy and annulus fibrosus defects).

Procedure ICD-10-PCS codes (inpatient)ICD-10

ICD-10-PCS

0RB30ZZ; 0RB33ZZ; 0RB34ZZ; 0RBB0ZZ; 0RBB3ZZ; 0RBB4ZZ; 0SB20ZZ; 0SB23ZZ; 0SB24ZZ; 0SB40ZZ; 0SB43ZZ; 0SB44ZZ (inpatient procedure codes for excision of vertebral disc; used only for inpatient services).

Imaging recency

Required imagingMagnetic resonance image (MRI) or CT myelogram of the relevant spine level obtained within the past 6 months

Diagnostic adjunctReport of selective nerve root injection results, if applicable to the diagnostic workup

Imaging purposeImaging must document level-appropriate nerve root compression that corresponds with clinical signs and symptoms

Annular defect size for Barricaid

Annular defect height and width (ISASS / Barricaid)4 to 6 mm tall and 6 to 10 mm wide (visualized intraoperatively) — FDA approval and ISASS description

FDA indication levelsSingle-level primary discectomy at L4-5 or L5-S1 specified for device use

ContextAnnular closure devices proposed for use in patients with large annular defects following lumbar discectomy

Annular defect width

ISASS example threshold (width)Large annular defects defined as ≥6 mm wide (ISASS recommendation notes defects between 6 and 10 mm wide; ≥6 mm cited as large),

Measurement timingAnnular defect width is to be visualized intraoperatively after discectomy per ISASS guidance

RelevanceWidth criterion is used to identify candidates for consideration of bone-anchored annular closure devices

Posterior disc height

Posterior disc height thresholdPosterior disc height ≥5 mm (moderately preserved disc height per ISASS)

Role in device candidacyMinimum posterior disc height requirement used in ISASS recommendations for considering annular closure devices

Measurement contextMeasured on preoperative imaging and referenced in trial eligibility for annular closure device studies

Prior Authorization, Documentation, and Billing

Prior Authorization

Prior authorization required per Codes table

Prior authorization is required for procedures listed in the policy's Codes table; see the Codes table for the specific CPT/HCPCS codes that are affected.

Prior Authorization

Verify plan-specific prior authorization and benefits

Determine prior authorization and coverage based on the member's specific benefit plan; the policy notes that plan-level benefit terms, exceptions, and mandates govern coverage and may differ by line of business.

Prior Authorization

Prior authorization must document failed conservative care (~6 weeks) or rapid progression

For elective discectomy, prior authorization submissions should document failure of conservative care of approximately 6 weeks (or presence of rapidly progressive neurologic deficit) with symptom duration and severity.

Document symptom duration and patient-reported outcome measures.
If surgery is earlier due to neuroprogression, include rationale for expedited intervention.

Prior Authorization

Authorization may require conservative-care and anatomic evidence (e.g., disc height ≥5 mm)

Prior authorization may require evidence both of prior conservative-treatment failure (≥6 weeks) and of anatomic thresholds used in trials (for example, minimum posterior disc height ≥5 mm and large annular defect dimensions when annular closure device is considered).

Trials enrolled patients who failed ≥6 weeks of nonsurgical care and had disc height ≥5 mm.
ISASS/trial anatomic criteria (e.g., large annular defect, ≥6 mm width) may be expected when device implantation is requested.

Documentation Required

Provide clinical documentation: failed conservative care or rapid deficit plus confirmatory imaging/electrodiagnostics

Authorization documentation should include either documented failure of approximately 6 weeks of conservative nonsurgical therapy or documentation of rapidly progressive neurologic deficit, plus confirmatory imaging (MRI or CT/myelogram) or electrodiagnostic testing correlating to the clinical findings.

MRI or CT myelogram within the past 6 months demonstrating nerve root compression at the level corresponding to symptoms.
If applicable, report selective nerve root injection results or electrodiagnostic studies that corroborate clinical findings.

Prior Authorization

Verify prior authorization rules per member plan

Always verify prior authorization requirements with the member's plan; the policy provides CPT/HCPCS and ICD-10/PCS code references but PA rules are subject to the member-specific benefit plan.

Reference the policy's Codes table when preparing submissions but confirm plan-specific PA processes.
Benefit exceptions or alternate administration by plan may change PA applicability.

Step Therapy

Require ≥6 weeks of defined conservative nonsurgical therapy before elective discectomy

Require at least 6 weeks of defined conservative nonsurgical therapy (prescription-strength analgesics including anti-inflammatories and at least 6 weeks of physical therapy/activity program) prior to elective discectomy unless rapidly progressive neurologic deficits are present.

Analgesics should include anti-inflammatory medications; adjunctive meds (nerve stabilizers, muscle relaxants) as appropriate.
Document participation in physical therapy or reason the individual could not tolerate it.

Step Therapy

Conservative care expected first (analgesics + activity program; ESI second-line)

Conservative therapy expectations include use of analgesics and a prescribed activity/exercise program as first-line, with epidural steroid injections typically considered second-line.

Epidural steroid injections may be used for short-term symptom relief but are generally second-line.
Document specifics of the activity program and analgesic regimen.

Documentation Required

Document conservative nonsurgical care and response prior to surgery

Conservative nonsurgical care (analgesics, activity/exercise programs, physical therapy; epidural steroid injections as second-line) is the standard initial treatment before considering discectomy; document interventions and response.

Record duration and response to each conservative intervention.
Note if epidural injections were administered and the clinical effect.

Step Therapy

For cervical discectomy, document stepwise conservative care before surgery

Cervical discectomy candidates in trials generally had progressive or refractory symptoms after a stepwise trial of conservative measures; prior authorization should reflect a stepwise conservative trial unless rapid neurologic deterioration is present.

Structured exercise programs were used in RCT comparators; document participation and outcomes.
If crossover to surgery occurred in trials, document patient-reported outcomes and timing relative to conservative therapy.

Step Therapy

Expect ~6 weeks of nonoperative management before discectomy unless emergent

Usual nonoperative management for approximately 6 weeks is expected prior to discectomy unless severe or rapidly progressing neurologic deficits mandate earlier surgery.

If proceeding earlier, provide clinical rationale and documentation of neurologic progression.
Include baseline patient-reported outcomes and timing of deterioration.

Note

Documentation Required

Document history, physical exam, and ≥6 weeks of conservative care (or reason intolerant)

Document history and physical exam findings including signs of radiculopathy or myelopathy and record at least 6 weeks of conservative care (or reason for intolerance) when submitting for authorization.

Include neurologic exam findings that localize symptoms to a level.
State prior treatments, durations, and patient adherence.

Documentation Required

Document that disc herniation is causing nerve compression and symptoms

Clinical documentation must demonstrate a disc herniation (extrusion) causing nerve compression with symptoms (pain, numbness, weakness) and that discectomy is being performed to relieve nerve compression.

Include imaging reports describing extrusion and nerve root compression at the symptomatic level.
Correlate imaging findings with history and exam.

Documentation Required

Provide outcome measures and detailed prior-care documentation

Document patient-reported outcomes at prespecified intervals (including baseline and prior to any secondary procedures) and record the duration and specifics of prior conservative care when justifying surgery.

Measure and record standardized outcomes (e.g., VAS, ODI) at baseline and follow-up.
List dates, types, and responses to prior conservative treatments.

Documentation Required

When requesting annular closure device, document trial-like eligibility (≥6 weeks failed care; disc height ≥5 mm)

Trial eligibility elements that informed device studies included prior nonsurgical treatment failure of ≥6 weeks and minimum disc height (≥5 mm); include similar documentation when device implantation (e.g., annular closure device) is requested.

For annular closure device consideration, document posterior disc height ≥5 mm and intraoperative annular defect dimensions.
Document failure of ≥6 weeks of nonsurgical treatment.

Documentation Required

Confirm radiculopathy on H&P and refractory disabling pain (~6 weeks) or progressive deficit

Required clinical documentation should confirm radiculopathy by history and physical exam and show disabling leg or back pain refractory to approximately 6 weeks of conservative care or progressive neurologic deficit.

Provide level-appropriate imaging showing nerve root compression.
If electing surgery for progressive deficit, document neurologic changes and timing.

Billing Rule

Reference benefit verification and policy when submitting claims

When submitting claims, reference member-specific benefit plan documentation and this medical policy; the policy's coding list is provided for reference but does not guarantee coverage or reimbursement.

Confirm that the CPT/HCPCS/ICD codes used align with the member's plan requirements.
Include policy references and relevant documentation in the claim or PA submission.

Denial Risk

Denial risk if medical necessity criteria not met (no radiculopathy/imaging correlation/insufficient conservative care)

Claims for lumbar or cervical discectomy may be denied when medical necessity criteria are not met — e.g., absence of radiculopathy or myelopathy, lack of imaging correlation with symptoms, or insufficient conservative therapy documentation.

Ensure history/exam corroborates imaging and symptom localization.
Provide clear documentation of the duration and specifics of prior conservative care.

Denial Risk

Plan/billing denial risk — coverage may vary by plan or mandate

Plan-level administration, benefit exceptions, and federal/state mandates can affect coverage; procedures may be denied if not consistent with the specific Plan's benefit terms or applicable laws.

Check whether the policy applies to the member's line of business (e.g., Medicare Advantage, Medicaid, Federal Employee Program).
Confirm any plan-specific exceptions or mandates before scheduling.

Denial Risk

Denial risk for failure to document adequate conservative care (~6 weeks)

Failure to document that conservative care was attempted for an appropriate duration (e.g., usual care for 6 weeks) may lead to denial of medical necessity for discectomy.

Record dates, interventions, adherence, and response to each conservative treatment.
If conservative care was not possible, document the clinical reason and supporting evidence.

Note

Evidence-derived clinical eligibility elements (may inform but are not explicit PA triggers)

Clinical trial eligibility elements (e.g., failed ≥6 weeks nonsurgical treatment, disc height ≥5 mm) are noted in the evidence and may inform clinical justification, although no explicit administrative PA triggers are specified.

Use trial eligibility elements to strengthen clinical justification when applicable.
Recognize that these are evidence-derived elements and not automatic PA requirements unless adopted by the plan.

Documentation Required

Document radiculopathy and imaging/electrodiagnostic confirmation to support necessity

Lack of documentation confirming radiculopathy by history/physical and correlating imaging or electrodiagnostic evidence may not support medical necessity; ISASS guidance requires such confirmation for consideration of some devices.

Include neurologic exam findings and imaging reports that localize nerve root compression.
When used, include nerve conduction/EMG or selective nerve root injection reports to corroborate symptoms.

Billing Rule

Coding list inclusion does not guarantee coverage or payment

Inclusion of a procedure or diagnosis code in the policy does not guarantee member coverage or reimbursement; coverage determinations remain subject to the member-specific benefit plan and this medical policy.

Do not assume coverage solely based on a code being listed in the policy's coding tables.
Verify code coverage and prior authorization requirements with the plan.

Background and Scope

Discectomy is a surgical procedure to remove herniated disc material compressing nerve roots. Lumbar discectomy may be performed as an open procedure or as a minimally invasive microdiscectomy (small incision, microscope visualization), and endoscopic lumbar decompression via transforaminal or interlaminar approaches is considered an acceptable surgical technique when the policy's clinical criteria are met. Cervical discectomy is commonly performed via an anterior approach and may be done with or without fusion; posterior minimally invasive foraminotomy is an alternative approach in selected cases.

Definitions and Key Terms

Microdiscectomy — definition

DefinitionMinimally invasive discectomy characterized by a small surgical incision (not an endoscopic port), use of a microscope for direct visualization, and removal of disc material under direct visualization

AdjunctsMay use tubular retractors to improve visualization or endoscopy to localize the operative site, but disc removal must be performed under direct visualization to qualify

Comparison to open discectomyMicrodiscectomy uses a smaller incision and visualization techniques and is associated with more rapid recovery in some trials

Persistent debilitating pain

VAS thresholdVisual analog scale (VAS) score greater than 4 defines significant daily pain

Functional impactPain must occur daily and have a documented impact on activities of daily living despite optimal conservative nonsurgical therapy

Context for surgeryPersistent debilitating pain by this definition supports consideration of discectomy when other criteria are met

Discectomy

Procedure definitionSurgical removal of part or all of one or more intervertebral discs to relieve pressure on affected nerve(s)

ApproachesApproaches include open discectomy, microdiscectomy (minimally invasive), anterior cervical discectomy (with or without fusion), and posterior cervical discectomy/foraminotomy

Primary indicationIntended to treat symptomatic disc herniation (extrusion) causing nerve compression presenting with pain, numbness, or weakness

Microdiscectomy — minimally invasive lumbar discectomy

Procedure characteristicsMinimally invasive lumbar discectomy using a smaller incision and visualization (often microscope or camera) to remove disc fragments, typically for smaller herniations

RecoveryAssociated with more rapid recovery compared with open discectomy in some controlled trials

ScopeReserved for cases where less resection is required; visualizes and removes extruded disc under direct visualization

Anterior cervical discectomy

ApproachOpen anterior approach via an incision in the anterior neck to access the cervical spine

FusionCommonly performed with simultaneous spinal fusion but can be done without fusion

VisualizationDisc is removed using direct visualization after soft tissues and muscles are retracted

Anterior cervical discectomy (open anterior neck incision)

Surgical approachOpen anterior neck incision with soft-tissue dissection to expose the cervical spine for disc removal

Typical practiceProcedure most commonly performed with fusion; disc removal under direct visualization

Alternative to posterior approachProvides anterior access to cervical pathology that may not be amenable to posterior foraminotomy

Posterior cervical discectomy and foraminotomy

ApproachPosterior approach using a small incision in the back of the neck with microscopic guidance to remove disc material and enlarge the foramen

IndicationOften used for foraminal or lateral disc pathology where posterior access is appropriate

TechniqueNerves and muscles are separated using a small retractor and special instruments are used to remove disc material

Annular closure device

Device descriptionA bone-anchored implant placed after lumbar discectomy intended to close large annular defects

GoalDesigned to reduce the risk of recurrent disc herniation and reoperation in patients with large annular defects

Clinical contextUsed following primary discectomy for patients with intraoperative large annular defects at eligible levels (L4-5 or L5-S1)

Key outcomes

Outcomes of interestSymptoms (pain), functional status, quality of life, treatment-related morbidity/mortality, reherniation, and reoperation

Measurement timingOutcomes assessed in trials up to multiple years including reherniation and reoperation endpoints

RelevanceThese outcomes inform coverage decisions and evaluation of annular closure devices and discectomy approaches

Large annular defect — ISASS definition

ISASS large annular defect definitionAnnular defect between 4 and 6 mm tall and between 6 and 10 mm wide visualized intraoperatively after discectomy

Use in recommendationsDefinition used by ISASS 2025 guidance to identify patients for consideration of annular closure devices

Measurement contextMeasured intraoperatively following discectomy to determine device candidacy

Moderately preserved disc height

Moderately preserved disc heightPosterior disc height ≥5 mm (ISASS-referenced threshold)

Role in candidacyMinimum disc height used in ISASS recommendations and trial eligibility for annular closure device consideration

MeasurementAssessed on preoperative imaging to confirm adequate disc height for device placement

Annular closure device (bone-anchored)

Device classificationBone-anchored annular closure device implanted at the discectomy site to close the annular defect and potentially reduce reherniation risk

Evidence sourcesDevice described and referenced in multiple randomized trials and policy updates summarized in the evidence sections

Coding notePolicy references procedure codes for implantation of bone-anchored annular closure device including annular defect measurement and sizing (see Codes table)

Policy Revision History

2026-06-25policy replaceLatest

Policy updated with literature review through April 24, 2026; references added and minor editorial refinements; effective 06/25/2026.

2025-06-25policy replace

Policy updated with literature review through April 21, 2025; policy statements unchanged; effective 06/25/2025.

2024-07-25policy replace

Added an indication for lumbar percutaneous endoscopic discectomy when other discectomy criteria are met; adopted changes effective 11/01/2024.

2024-06-27policy replace

Policy updated with literature review through May 8, 2024; policy statements unchanged; effective 06/27/2024.

2023-10-26policy replace

New evidence review and investigational policy statement added for annular closure devices; policy updated with literature review through July 28, 2023; effective 02/01/2024.

2023-07-27policy replace

Policy updated with literature review through May 1, 2023; minor editorial refinements; policy number updated from 7.01.146; effective 07/27/2023.

2022-06-30policy replace

Policy updated with literature review through April 16, 2022; minor editorial refinements to policy statements; effective 06/30/2022.

2021-06-24policy replace

Blue Cross of Idaho adopted changes with literature review through May 3, 2021; policy statements unchanged; effective 06/24/2021.