Discography
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Defines Centene-affiliated health plan coverage stance and criteria for lumbar, cervical, and thoracic discography procedures for members/enrollees; intended for providers deciding on diagnostic discography and submitting authorizations/claims.
No material clinical or coverage changes in this revision.
Coverage Criteria
Lumbar discography - Not medically necessary
Policy statements
per Centene clinical policy
Cervical/Thoracic discography - Insufficient evidence
Policy statements
procedures are controversial and lack validation/controlled outcome studies; literature is sparse and of poor quality.
The available literature for cervical and thoracic discography is limited and methodologically weak. Published reviews note an absence of validation and controlled outcome studies, a paucity of studies overall, and several that are of poor quality. Because of these evidence gaps, the procedure’s diagnostic utility and safety for cervical and thoracic indications remain unproven.
It is the policy of Centene-affiliated health plans that lumbar discography is not medically necessary because the evidence indicates the procedure is not safe or effective.
Coding
| 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 & Authorization
Prior authorization expectations
Requests for discography require prior authorization. Anticipate denial for lumbar discography because the policy states it is not medically necessary. Cervical and thoracic discography requests should include supporting documentation demonstrating medical necessity given insufficient evidence in the literature.
- Lumbar discography: high denial risk — submit only if seeking peer review (policy states not medically necessary).
- Cervical/thoracic discography: provide detailed rationale and prior imaging/literature support.
Conservative / step notes
Other imaging must not have confirmed the source of suspected discogenic pain, and the pain should be non-radicular per guidance (e.g., UpToDate and Manchikanti et al.). Document prior conservative management steps and that less invasive diagnostic options were considered or performed without identifying the pain source.
- Confirm prior imaging did not identify the disc as the pain source.
- Document that pain is non-radicular.
- Include records of conservative treatment trials and their durations/outcomes.
Coding documentation
Submit appropriate CPT codes and supporting documentation for each level tested and for radiological supervision and interpretation. Coding should reflect the specific procedure and anatomic region.
- Use CPT 62290 for lumbar discography injection procedure, each level.
- Use CPT 62291 for cervical or thoracic discography injection procedure, each level.
- Use CPT 62292 for chemonucleolysis including discography (lumbar) when applicable.
- Use CPT 72285 for cervical or thoracic discography radiological supervision and interpretation.
- Use CPT 72295 for lumbar discography radiological supervision and interpretation.
- Ensure coding aligns with current AMA CPT guidance; inclusion of codes here is informational and does not guarantee coverage.
Denial risk for lumbar discography
Lumbar discography will typically be denied as not medically necessary per this policy. Providers should not expect routine approval for lumbar discography and should document strong justification if pursuing authorization or appeal.
- Policy statement: lumbar discography considered not medically necessary.
- Consider alternative diagnostic approaches or obtain peer review prior to authorization submission.
Background
Discography is an invasive intradiscal diagnostic technique in which contrast medium is injected into an intervertebral disc to attempt to reproduce the patient’s pain and to evaluate disc morphology; it is used with the intent of identifying a disc as the source of axial (discogenic) pain and to help inform decisions about surgical intervention.
Definitions
Conservative Treatment Requirements
Document absence of other imaging-confirmed discogenic source and non-radicular pain when relevant to requests.
Per policy coding implications and prior revisions; include prior imaging reports and clinical characterization of pain.
Imaging Requirements
Provide prior imaging documentation (e.g., MRI)
When requesting review, include prior imaging (e.g., MRI) reports showing that imaging did not confirm the source of discogenic pain.
- Attach prior MRI or other imaging reports demonstrating absence of an imaging-confirmed discogenic source
Not Covered / Exclusions
Lumbar discography is not medically necessary and will not be covered by Centene-affiliated health plans because available evidence indicates the procedure is not safe or effective.
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