CurrentBluecross IdahoPolicy MP 7.01.585

Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures

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This policy defines when invasive and noninvasive electrical bone growth stimulation are considered medically necessary as adjuncts to spinal fusion procedures and lists indications considered not medically necessary. It applies to Blue Cross of Idaho benefit plans and to providers requesting coverage determinations.

Policy Summary

PayerBluecross Idaho

PolicyElectrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures

Policy CodePolicy MP 7.01.585

Change TypeNo material changes

Effective DateMay 28, 2026

Last ReviewMay 28, 2026

Next Review DateMay 28, 2026

Key ActionInclude operative plan, prior fusion history, and documentation of high-risk criteria or persistent nonunion when requesting prior authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7 RCTsRCTs in meta-analysis

OR=2.53Radiographic fusion effect

3Cervical multilevel threshold

Class 3

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CurrentBluecross IdahoPolicy MP 7.01.585

Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures

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Policy Summary

PayerBluecross Idaho

PolicyElectrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures

Policy CodePolicy MP 7.01.585

Change TypeNo material changes

Effective DateMay 28, 2026

Last ReviewMay 28, 2026

Next Review DateMay 28, 2026

Key ActionInclude operative plan, prior fusion history, and documentation of high-risk criteria or persistent nonunion when requesting prior authorization.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7 RCTsRCTs in meta-analysis

OR=2.53Radiographic fusion effect

3Cervical multilevel threshold

Class 3

Mar 4, 2026Search date

Coverage Criteria — When Electrical Bone Growth Stimulation Is Covered

Medically necessary adjunct electrical stimulation

Covered when ANY one of the following high-risk criteria is present:

Lumbar fusion - high risk: Either invasive or noninvasive electrical bone growth stimulation may be considered medically necessary as an adjunct to lumbar spinal fusion surgery in individuals at high risk for fusion failure, defined as any one of the following: one or more previous failed spinal fusion(s) (defined as a spinal fusion that has not healed at a minimum of 6 months after the original surgery, as evidenced by serial radiographs over a course of 3 months); grade 3 or worse spondylolisthesis; fusion to be performed at 2 or more levels (2 or more motion segments - 3 vertebrae); current nicotine use; diabetes; renal disease; alcoholism; steroid use.any one criterion

Supports both invasive and noninvasive methods for lumbar fusion

Cervical fusion - noninvasive only: Noninvasive electrical bone growth stimulation may be considered medically necessary as an adjunct to cervical spinal fusion surgery in individuals at high risk for fusion failure, defined as any one of the following: one or more previous failed spinal fusion(s) (defined as a spinal fusion that has not healed at a minimum of 6 months after the original surgery, as evidenced by serial radiographs over a course of 3 months); fusion to be performed at three (3) or more adjacent levels (3 or more motion segments - 4 vertebrae) when any of the following are present: current nicotine use; diabetes; osteoporosis.any one criterion

Specifies noninvasive stimulation for cervical fusion and requires multilevel fusion plus at least one listed risk factor

Invasive Electrical Bone Growth Stimulation — Evidence Summary

Summary of evidence and context for use

Invasive electrical stimulation evidence summary: Two randomized controlled trials (one in instrumented fusion and one in noninstrumented fusion) and comparative series in high-risk populations demonstrated improved radiographic fusion with implantable electrical stimulation; some studies reported associated improved functional outcomes on select measures.

Trials had risk of bias (dropouts, incomplete blinding of patients/surgeons) but included blinded radiographic assessment (CT) as an objective outcome.

Noninvasive Electrical Bone Growth Stimulation — Evidence Context

Noninvasive electrical stimulation context

Noninvasive stimulation — evidence review stage: Noninvasive electrical bone growth stimulation is being evaluated for individuals at high risk of lumbar spinal fusion failure; PICO is defined for these evaluations, but specific trial outcome data are not presented in this excerpt.

Further outcome details for noninvasive modalities are summarized elsewhere (meta-analysis) but individual PICO results are not provided in these chunks.

Covered Indications

Covered when evidence-supported criteria are met:

Postoperative adjunct use: Postoperative noninvasive electrical bone growth stimulation may be used as an adjunct to lumbar spinal fusion to promote radiographic fusion; a meta-analysis of randomized controlled trials (7 RCTs, n=941) demonstrated increased odds of successful fusion (OR=2.53, 95% CI 1.86–3.43).

Supported by moderate-level evidence from a 7-RCT meta-analysis

Nonoperative salvage for failed fusion: Noninvasive electrical stimulation may be considered as a nonoperative salvage option when clinical documentation demonstrates persistent nonunion and the patient is an appropriate candidate for conservative management.

Supported primarily by uncontrolled studies and at least one FDA-labeled device indication (e.g., Spinal-Stim)

Noninvasive electrical stimulation for failed lumbar fusion (salvage)

Covered when ALL of the following are met:

Salvage therapy criteria: 1) Clinical documentation demonstrates persistent nonunion (failed spinal fusion). 2) Patient is an appropriate candidate for conservative (nonoperative) management. 3) Use is as a nonoperative salvage option rather than routine adjunct to primary surgery.

Based on review supporting noninvasive electrical stimulation as salvage when persistent nonunion and conservative management candidacy are documented; exact durations of prior conservative care are not specified in this excerpt.

Invasive or noninvasive electrical stimulation in cervical spinal fusion

Evidence and coverage stance:

Cervical fusion evidence: 1) One randomized controlled trial in anterior cervical fusion populations showed mixed radiographic fusion benefits at intermediate time points but no consistent improvement in clinical outcomes; 2) Uncontrolled cohort data suggest improved fusion rates in high-risk patients but have methodological limitations; 3) Additional randomized controlled trials are required to establish effectiveness in cervical fusion.

Efficacy for routine use in cervical fusion is not established due to methodological limitations of available trials.

Covered indications (high-risk or failed fusion)

Covered when ALL of the following are met (per referenced guidelines and Medicare):

High-risk augmentation scenarios: Patient undergoing spinal fusion who is at high risk for pseudarthrosis as defined by one or more of: fusion of 2 or more motion segments (3 vertebrae), revision spinal fusion (previous failed fusion), inability to stop smoking for fusion due to underlying condition, or specified comorbidities (diabetes; long-term corticosteroid-treated inflammatory arthritis; immunocompromised state; systemic vascular disease; osteopenia/osteoporosis).

Recommendation aligned with NASS 2025 guidance

Medicare failed-fusion indication: Failed fusion where at least 9 months have elapsed since the last surgery.>=9 months since prior surgery

Medicare NCD 150.2

Not indicated / not covered scenarios (per NASS 2025):

Not indicated (per NASS 2025):

Not indicated scenarios: Primary (index) spinal fusions without additional risk factors; spinal fusion of 1 motion segment (2 vertebrae) without additional risk factors; presence of malignancy; presence of infection.

Use in these scenarios is NOT indicated and may be denied

Requests for semi-invasive electrical bone growth stimulation (devices using percutaneous electrodes with external power supplies) are explicitly excluded and considered not medically necessary for any indication. Also considered not medically necessary are the use of electrical stimulation as an adjunct for primary bone healing of a spinal fracture and as a nonsurgical treatment of an established pseudoarthrosis. These exclusions are stated to limit application to the device types and clinical scenarios addressed in this policy and to avoid coverage for approaches that lack supporting evidence in this context.

The literature selection process excluded studies with duplicative or overlapping populations to avoid double-counting participants and inflating evidence strength. This methodological rule was applied when assembling comparative trials and observational studies for the efficacy assessment.

Evidence for noninvasive electrical stimulation used as a nonoperative salvage option for failed fusion is limited and largely derived from uncontrolled series; a search of ClinicalTrials.gov through March 2026 did not identify ongoing trials likely to change conclusions. The policy notes at least one FDA-labeled product for salvage use (e.g., Spinal‑Stim), but emphasizes that controlled trials for this indication are sparse.

Only a single randomized controlled trial was identified for cervical spinal fusion, and the body of cervical evidence is constrained by methodological limitations. Reported trials showed marginal or inconsistent differences in fusion rates and no reliable benefit in functional outcomes; uncontrolled cohort data used historical controls or lacked blinding. Because of these design weaknesses, the policy concludes that effectiveness of electrical stimulation for routine cervical fusion augmentation has not been established.

The policy explicitly excludes use of electrical stimulation when there is presence of malignancy or presence of infection at the intended fusion site. These clinical scenarios are identified as not indicated by professional-society guidance and therefore are listed as coverage exclusions.

Other scenarios identified as not medically necessary include routine use of semi-invasive stimulators, adjunctive stimulation for primary spinal-fracture healing, and nonsurgical treatment of an established pseudoarthrosis outside the narrow salvage pathway. Additionally, use of noninvasive stimulation for failed fusion without documented persistent nonunion or when the patient is not an appropriate candidate for conservative, nonoperative management is not supported as medically necessary.

Several randomized trials and meta-analyses informing the policy had limitations that increase risk of bias and reduce certainty. Examples include high dropout rates and missing functional outcome data (Andersen et al.), lack of blinding of patients or surgeons in some trials, and potential selective follow-up that may favor responders. Although blinded radiographic assessment (including CT) was used in some studies and a 7‑trial meta-analysis showed an increased odds of radiographic fusion (OR=2.53), these trial-level biases temper confidence in estimated clinical benefits and are cited as a reason for cautious coverage statements.

Coding, Device Identifiers, and Procedural Thresholds

Regulatory / product codesmixed

FDA product codes LOE	invasive bone growth stimulator
FDA product codes LOF	noninvasive bone growth stimulator

Device identifiers listed in policy excerptmixed

P190030	ActaStim-S Spine Fusion Stimulator (PMID/PMAn reference number as listed in document)
P230025	Xstim Spine Fusion Stimulator (identifier listed in document)
P79000	OsteoStim (implantable spinal fusion device identifier listed in document)
P850035	SpF Implantable Spinal Fusion (identifier listed in document)

CPT codesCPT

20974	Electrical stimulation to aid bone healing; noninvasive (non-operative).
20975	Electrical stimulation to aid bone healing; invasive (operative).

HCPCS codesHCPCS

E0748	Osteogenesis stimulator, electrical, non-invasive, spinal applications.
E0749	Osteogenesis stimulator, electrical (surgically implanted).

ICD-10-CM diagnosis codesICD-10

M43.15-M43.17	Spondylolisthesis lumbar region code range.
M48.05-M48.07	Spinal stenosis lumbar region code range.
M51.04-M51.9	Thoracic, thoracolumbar, and lumbosacral intervertebral disc disorders code range.

ICD-10-PCS procedure codesICD-10

00HU0MZ, 00HU3MZ	Insertion, spinal canal, neurostimulator lead (ICD-10-PCS examples).
00HV0MZ, 00HV3MZ, 00HV4MZ	Insertion, spinal cord, neurostimulator lead (ICD-10-PCS examples).
00WU0MZ, 00WU3MZ, 00WU4MZ, 00PV0MZ, 00PV3MZ	Removal, spinal canal or spinal cord neurostimulator lead (ICD-10-PCS examples).
00WV4MZ, 00WV0MZ, 00WV3MZ	Revision, spinal canal or spinal cord neurostimulator lead (ICD-10-PCS examples).

inv-25: fusion levels threshold

Lumbar thresholdFusion to be performed at 2 or more levels (2+ motion segments = 3 vertebrae)

Cervical thresholdFusion to be performed at 3 or more adjacent levels (3+ motion segments = 4 vertebrae) when accompanied by at least one listed risk factor (e.g., nicotine use, diabetes, osteoporosis)

ApplicabilityLumbar threshold supports either invasive or noninvasive stimulation; cervical threshold specifies noninvasive stimulation only

Provider Actions — Prior Authorization, Documentation, and Denial Risk

Prior Authorization

Include operative plan, prior fusion history, and risk factors with authorization

Prior authorization requests should include the operative plan (levels to be fused), history of any prior fusion(s), and comorbid risk factors that demonstrate the patient is at high risk for nonunion. Include documentation of planned fusion levels and relevant clinical history to support adjunctive electrical stimulation.

Operative plan: specific levels to be fused
History of prior fusion(s) and radiographic evidence of nonunion when applicable
Comorbid risk factors (e.g., current nicotine use, diabetes, renal disease, alcoholism, steroid use)

Note

No procedural/billing prior authorization details in excerpt

The excerpt does not specify procedural billing workflows or an explicit prior authorization process for all requests; procedural and billing details are not provided in the cited sections.

Background and Scope

Electrical bone growth stimulators encompass three delivery approaches: invasive devices that require surgical implantation of a generator and intrafusion electrodes, noninvasive devices that apply pulsed electromagnetic fields or capacitive coupling via skin pads or coils, and semi‑invasive systems that use percutaneous leads with external power. These technologies have been investigated as adjuncts to spinal fusion to increase the probability of radiographic union; noninvasive devices are also evaluated as a nonoperative salvage option for failed fusion. Treatment durations, daily wear times, and the need for surgical removal differ by device type, and the policy aligns coverage decisions with available controlled evidence for each modality.

Definitions and Key Terms

inv-47: Invasive stimulator — device requiring surgical implantation of generator and electrode

DefinitionDevice requiring surgical implantation of a current generator in an intramuscular or subcutaneous space with an electrode implanted within bone graft at the fusion site; generator typically remains functional for 6–9 months

Typical managementGenerator is often removed in a second surgical procedure when stimulation is completed; the electrode may or may not be removed

Risk profileImplantable electrodes provide constant stimulation but carry increased risks associated with implantable leads

inv-48: Noninvasive stimulator — externally applied devices (PEMF, capacitive coupling, combined magnetic fields)

DefinitionExternally applied devices that generate a weak electrical current at the target site using pulsed electromagnetic fields, capacitive coupling, or combined magnetic fields

Policy Revision History

2026-05-28policy updateLatest

Policy replaced and updated with literature review through March 4, 2026; policy statements edited for clarity with intent preserved; effective date 2026-05-28.

2025-05-29policy update

Policy replaced and updated with literature review through April 4, 2025; references added; effective date 2025-05-29.

2024-12-19policy update

Policy Summary

PayerBluecross Idaho

PolicyElectrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures

Policy CodePolicy MP 7.01.585

Change TypeNo material changes

Effective DateMay 28, 2026

Last ReviewMay 28, 2026

Next Review DateMay 28, 2026

Key ActionInclude operative plan, prior fusion history, and documentation of high-risk criteria or persistent nonunion when requesting prior authorization.

SourceLink

On This Page

Prior Authorization

Authorization should be supported by documentation of persistent nonunion and conservative-management candidacy

Prior authorization is expected to be supported by clinical documentation showing persistent nonunion and that the patient is an appropriate candidate for conservative, nonoperative management before noninvasive stimulation is used as salvage therapy.

Document persistent nonunion (failed fusion) and suitability for conservative care

Prior Authorization

Document persistent nonunion and conservative-salvage candidacy for noninvasive stimulation

When requesting noninvasive electrical stimulation as a nonoperative salvage for failed lumbar fusion, include clinical documentation demonstrating persistent nonunion and rationale that the patient is an appropriate candidate for conservative management.

Evidence of persistent nonunion
Statement that the patient is appropriate for nonoperative salvage (conservative management)

Billing Rule

Reference CPT (20974, 20975) and HCPCS (E0748, E0749) in authorization requests

Ensure any prior authorization or coverage request references the applicable CPT and HCPCS codes for electrical osteogenesis stimulators.

CPT codes: 20974 (noninvasive), 20975 (invasive)
HCPCS codes: E0748 (noninvasive), E0749 (surgically implanted)

Step Therapy

No step therapy mandated in this excerpt

No step therapy requirements are specified in this portion of the policy.

Note

Comparator: lumbar fusion without electrical stimulation; no step-therapy mandate

The comparator in the evidence and policy context is lumbar spinal fusion without electrical stimulation; the policy does not impose a step-therapy mandate requiring fusion without stimulation first.

Comparator: lumbar fusion surgery without invasive electrical stimulation

Step Therapy

Document prior/concurrent conservative management when using stimulation as salvage

Because noninvasive stimulation is described as a nonoperative salvage option, clinicians should document prior or concurrent conservative management efforts when seeking coverage.

Document prior conservative treatments or rationale for nonoperative management candidacy

Step Therapy

Use stimulation as nonoperative salvage when conservative management appropriate

Electrical stimulation as described is intended for use as a nonoperative salvage option when conservative management is appropriate; clinicians should document that nonoperative measures are suitable and have been considered.

Clarify that electrical stimulation is being used as nonoperative salvage rather than routine adjunct to primary surgery

Prior Authorization

Medicare-based expectations: ≥9 months since prior surgery and high-risk adjunctive use

Medicare coverage notes that noninvasive stimulation for failed fusion is covered when at least 9 months have elapsed since the last surgery, and that adjunctive use is recognized for multiple-level or previously failed fusions; use these prerequisites as expected clinical context when requesting coverage.

Medicare failed-fusion requirement: minimum of 9 months since last surgery
Medicare recognizes adjunctive use for multiple-level fusion or previously failed fusion

Documentation Required

Document one or more policy-listed high-risk criteria to support necessity

Clinical documentation supporting medical necessity should demonstrate the presence of one or more high-risk criteria (e.g., prior failed fusion, grade 3+ spondylolisthesis, multilevel fusion thresholds, current nicotine use, diabetes) as listed in the policy.

One or more high-risk criteria per policy (prior failed fusion, grade ≥3 spondylolisthesis, multilevel fusion thresholds, nicotine use, diabetes, renal disease, alcoholism, steroid use, osteoporosis for cervical)

Documentation Required

Include radiographic fusion assessments (CT when available) and functional outcomes

Randomized trials cited in the policy used blinded radiographic evaluation, including CT, and functional outcome measures; include radiographic fusion assessments (CT when available) and functional outcome data where applicable in documentation.

Blinded radiographic evaluation (including CT) was used in trials
Functional outcome measures (e.g., Dallas Pain Questionnaire) were reported

Documentation Required

Show persistent nonunion and candidacy for conservative management

Required clinical documentation for noninvasive stimulation should demonstrate persistent nonunion (failed lumbar spinal fusion) and provide rationale that the patient is an appropriate candidate for conservative, nonoperative salvage management.

Evidence of persistent nonunion
Rationale that patient is appropriate for conservative, nonoperative salvage

Documentation Required

For salvage requests, document persistent nonunion and appropriateness for conservative care

For nonoperative salvage use, clinical documentation must show persistent nonunion and that the patient is an appropriate candidate for conservative care rather than immediate repeat surgery.

Document that nonoperative salvage is clinically appropriate and preferred over repeat operative intervention at this time

Documentation Required

Include timing (≥9 months) and high-risk features when available

Supportive documentation should include timing and high-risk features, for example failed fusion occurring at least 9 months after prior surgery or presence of multilevel fusion or prior failed fusion to justify adjunctive stimulation.

Timing: failed fusion ≥9 months since prior surgery (per Medicare)
High-risk features: multilevel fusion (3+ vertebrae), prior failed fusion

Denial Risk

Do not request coverage for semi‑invasive stimulators or excluded indications (will be denied)

Requests for semi-invasive stimulators, use as an adjunct for primary spinal fracture healing, or nonsurgical treatment of established pseudoarthrosis are considered not medically necessary and would be denied.

Semi-invasive electrical bone growth stimulation for any indication
Adjunctive use for primary spinal fracture healing
Nonsurgical treatment of established pseudoarthrosis

Note

Excluded duplicative/overlapping studies — methodological note, not a denial trigger

Studies with duplicative or overlapping populations were excluded from the evidence review; this is a methodological note and not itself a direct denial trigger for coverage.

Denial Risk

Denial risk if persistent nonunion and conservative-management candidacy are not documented

Lack of clinical documentation demonstrating persistent nonunion and that the patient is an appropriate candidate for conservative management could lead to denial of coverage for noninvasive stimulation as salvage therapy.

Failure to document persistent nonunion and conservative-management candidacy risks denial

Denial Risk

Denial risk from insufficient evidence or missing documentation

Absence of high-quality controlled evidence for certain salvage indications, or failure to document persistent nonunion and conservative-management candidacy, may result in denial due to insufficient evidence/documentation.

Insufficient evidence for salvage indications beyond uncontrolled studies
Document persistent nonunion and conservative-care candidacy to mitigate denial risk

Denial Risk

Claims for scenarios explicitly not indicated by NASS (e.g., primary one-level fusions, malignancy, infection) risk denial

Per NASS 2025, electrical stimulation is NOT indicated for primary spinal fusions without additional risk factors, single-motion-segment (one-level) fusions without risk factors, presence of malignancy, or presence of infection; claims in those scenarios risk denial.

Primary (index) spinal fusions without listed risk factors
Spinal fusion of 1 motion segment (2 vertebrae) without risk factors
Presence of malignancy or infection

Capacitive coupling uses skin pads worn up to 24 hours/day (or up to 9 months); PEMF uses treatment coils worn 6–8 hours/day for 3–6 months; combined magnetic fields may involve 30 minutes/day for 9 months

Practical notePatient compliance may be an issue with externally worn devices

inv-49: Semi-invasive stimulator — percutaneous electrodes with external power supply

DefinitionPercutaneous electrodes connected to an external power supply, avoiding surgical removal of a generator (semi-implantable approach)

Distinguishing featureRequires percutaneous access but not full implantation of a subcutaneous generator

Policy stanceSemi-invasive electrical bone growth stimulation is considered not medically necessary for any indication in this policy

inv-50: High-risk of lumbar spinal fusion failure — enumerated patient risk factors

Enumerated risk factorsPrevious failed spinal fusion (nonunion ≥6 months with serial radiographs over 3 months)

Additional risk factorsGrade 3 or worse spondylolisthesis; fusion of 2 or more levels (lumbar) or multiple-level fusion as defined by payer/society guidance

Comorbid risksCurrent nicotine use, diabetes, renal disease, alcoholism, long-term steroid use, older age, low bone mineral density/osteoporosis

inv-51: Invasive electrical bone growth stimulation — implantable stimulators as adjuncts to fusion

DefinitionImplantable electrical stimulators placed as an adjunct to spinal fusion surgery to promote bone growth (implantable generator + electrode)

Evidence summaryTwo RCTs and comparative series in high-risk populations demonstrated improved radiographic fusion and some functional benefits with invasive stimulation

Examples/identifiersDevice examples listed in policy include ActaStim-S, Xstim, OsteoStim, SpF Implantable Spinal Fusion (product identifiers cited)

inv-52: Noninvasive electrical bone growth stimulation — external adjunct devices

DefinitionExternal electrical stimulation devices applied without implantation as adjuncts to spinal fusion (PEMF, capacitive coupling, combined magnetic fields)

Evidence basisMeta-analysis of RCTs (Akhter et al) found increased odds of radiographic fusion (OR=2.53) for postoperative electrical stimulation including noninvasive types

Clinical useUsed postoperatively as adjuncts and also evaluated as nonoperative salvage for failed fusion

inv-53: Noninvasive electrical bone growth stimulation — therapies such as PEMF, direct current, capacitive coupling

Therapies includedPulsed electromagnetic fields (PEMF), direct current, and capacitive coupling are specified noninvasive modalities

Delivery specificsCapacitive coupling: skin pads; PEMF: coils in brace or on skin; combined magnetic fields: time-varying + static field

Treatment durationsExamples range from daily wear (hours) for 3–9 months depending on modality

inv-54: Failed lumbar spinal fusion / persistent nonunion — radiographic nonunion definition and context

Radiographic nonunion definitionPrior lumbar spinal fusion that has not healed at a minimum of 6 months after the original surgery, evidenced by serial radiographs over a course of 3 months

Clinical contextPersistent nonunion (failed fusion) is the indication for considering noninvasive stimulation as a nonoperative salvage option

Evidence qualityAvailable evidence for salvage is largely uncontrolled studies; FDA labels (e.g., Spinal-Stim) exist for nonoperative salvage

inv-55: Electrical bone growth stimulation — definition covering invasive and noninvasive therapies

DefinitionTherapies that deliver electrical or electromagnetic stimulation—invasive (implantable) or noninvasive (external)—intended to promote bone healing in spinal fusion procedures

Modalities coveredIncludes implantable generators and electrodes, PEMF, capacitive coupling, combined magnetic fields, and direct current approaches

Intended useUsed as adjuncts to spinal fusion surgery to increase probability of radiographic fusion and, in salvage contexts, to promote union without repeat surgery

inv-56: Target population — individuals undergoing cervical or with failed cervical/lumbar fusion

Primary target populationIndividuals undergoing cervical spinal fusion surgery

Secondary populationIndividuals with failed cervical or lumbar spinal fusion surgery being considered for nonoperative salvage with noninvasive stimulation

ScopePolicy applies to both implantable and noninvasive devices when coverage criteria are met

inv-57: Multiple level fusion / high-risk fusion — definition (3+ vertebrae) and implication

DefinitionMultiple-level fusion involves 3 or more vertebrae (example: L3–L5, L4–S1) and is considered a high-risk scenario for pseudoarthrosis

Policy implicationMultiple-level (3+ vertebrae) fusion supports coverage for invasive or noninvasive augmentation in high-risk patients per Medicare and NASS guidance

Associated high-risk conditionRevision (previous failed fusion) at the same site is also considered high risk

Policy replaced and adopted changes effective 04/01/2025 to include indication for noninvasive electrical bone growth stimulation as an adjunct to cervical spinal fusion when specific criteria are met; policy number updated.

2024-04-25policy update

Policy replaced and updated with literature review through March 2, 2024; policy statement unchanged; effective date 2024-04-25.

2023-04-27policy update

Policy replaced and updated with literature review through January 16, 2023; minor editorial refinements to policy statements; effective date 2023-04-27.

2022-04-28policy update

Policy replaced and updated with literature review through January 17, 2022; policy statements unchanged; effective date 2022-04-28.

2021-04-22policy adoption

Policy replaced and adopted changes with literature review through March 6, 2021; policy statements unchanged; effective date 2021-04-22.