CurrentCentenePolicy CP MP.114

Disc Decompression Procedures

Defines medical necessity criteria for open discectomy and microdiscectomy for symptomatic lumbar disc herniation and states Centene's stance on various minimally invasive discectomy (MID) techniques (not proven superior / not supported). Applies to health plans affiliated with Centene Corporation.

Policy Summary

PayerCentene

PolicyDisc Decompression Procedures

Policy CodePolicy CP MP.114

Change TypeClarifiedsplit from CP.MP.63

Effective Date

Next Review Date

Key ActionProvider must document imaging-confirmed nerve root compression and relevant MRC muscle strength scores and conservative therapy trials to meet medical necessity.

SourceLink

POLICY UPDATE CHANGES

Policy split from CP.MP.63 and clarified that open discectomy and microdiscectomy are medically necessary while listed minimally invasive discectomy procedures are not supported as superior.

1Required severe motor deficit threshold (MRC score)

4wMinimum duration for physical therapy/activity modification before surgery

3wMinimum NSAID/acetaminophen trial duration

multipleListed MID techniques not supported as superior

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