CurrentCentenePolicy CP MP.115

Clinical Policy: Discography

This policy addresses the medical necessity and coverage stance for lumbar, cervical, and thoracic discography for members of Centene-affiliated health plans, guiding providers on when discography is considered not medically necessary or unsupported by evidence.

Policy Summary

PayerCentene

PolicyClinical Policy: Discography

Policy CodePolicy CP MP.115

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionDo not authorize lumbar discography as it is considered not medically necessary; document applicable CPT codes if billing.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not medically necessaryLumbar coverage

Insufficient evidenceCervical/Thoracic coverage

5Procedure codes

Accelerated degenerationPotential harm noted

Coverage Criteria for Discography

inv-01: Lumbar discography — Not medically necessary

Covered when ALL of the following are met:

I: Lumbar discography is considered not medically necessary because evidence indicates the procedure is not safe or effective.

Policy statement I

inv-02: Cervical and thoracic discography — Insufficient evidence

II: There is insufficient evidence in the published peer-reviewed literature to support the use of cervical and thoracic discography.

Policy statement II

Cervical and thoracic discography are considered investigational due to limited and low-quality evidence. The literature notes an absence of validation studies and a lack of controlled outcome research, with only a small number of poor-quality studies available. Because of these gaps, the published peer-reviewed evidence is insufficient to support the use of cervical or thoracic discography.

Policy Summary

PayerCentene

PolicyClinical Policy: Discography

Policy CodePolicy CP MP.115

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionDo not authorize lumbar discography as it is considered not medically necessary; document applicable CPT codes if billing.

SourceLink

On This Page

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Provider Actions, Billing and Prior Authorization

Prior Authorization

Prior Authorization Required

Prior authorization is required for discography procedures. Requests for lumbar discography will be denied as not medically necessary.

Affected codes: 62290, 62292, 62291, 72285, 72295
Lumbar discography: requests denied (not medically necessary)

Note

Policy background — discography

Lumbar discography is considered not medically necessary by Centene-affiliated health plans due to evidence showing the procedure is not safe or effective. Cervical and thoracic discography have insufficient evidence in the published peer‑reviewed literature to support their use.

Lumbar discography: not medically necessary
Cervical and thoracic discography: insufficient evidence

Note

Background note — clinical context for discography

Discography may only be contemplated in the clinical literature after other potential sources of lumbar pain have been excluded and when surgery is being considered; however, Centene policy treats lumbar discography as not medically necessary. Evidence and guidelines note concerns about reliability, potential to accelerate disk degeneration, and limited ability to predict surgical outcomes.

Discography considered in literature only after exclusion of other lumbar pain sources and when surgery is being considered
Evidence of possible accelerated disk degeneration and limited predictive value for surgical outcomes

Documentation Required

Billing and documentation requirements

When submitting claims or authorization requests include applicable CPT codes and supporting documentation of prior imaging and clinical evaluation. Note that inclusion of codes does not guarantee coverage; providers should use current coding guidance.

Include applicable CPT codes: 62290, 62291, 62292, 72285, 72295
Attach prior imaging reports showing no confirmed source of discogenic pain and documentation that surgery is being considered

Denial Risk

Denial Risk — lumbar discography

Denial trigger: lumbar discography requests will be denied as not medically necessary per policy. Authorization of cervical or thoracic discography may be unsupported due to insufficient evidence.

Lumbar discography: automatic denial (not medically necessary)
Cervical/thoracic discography: likely not supported due to insufficient evidence

Conservative Treatment and Exclusion Requirements

inv-12: Other possible sources of lumbar pain should be excluded before considering discography (policy still deems lumbar discography not medically necessary)

Before any consideration of discography, other potential sources of lumbar pain must be excluded; however, even when these requirements are considered, lumbar discography is deemed not medically necessary by this policy.

Other possible sources of lumbar pain have been excluded through appropriate evaluation and imaging prior to consideration of discography.

From background and policy history; exclusion of other sources is required before consideration

Imaging (e.g., MRI, radiographs, myelography) should not have identified a confirmed source of discogenic pain prior to consideration of discography.

Policy history notes that other imaging must not have confirmed the source of discogenic pain

Even when other sources of lumbar pain are excluded and surgery is being considered, lumbar discography is considered not medically necessary due to insufficient evidence of safety and effectiveness.

Policy conclusion

Imaging Requirements Before Consideration

Documentation Required

Imaging prerequisite: no prior imaging-confirmed source of discogenic pain

Before considering discography, other imaging should not have identified a confirmed source of discogenic pain; discography is not a standalone validated test and background notes imaging can show symptomatic and asymptomatic abnormalities.

Policy history added requirement that other imaging must not have confirmed the source of discogenic pain
Guidance notes MRI and other imaging identify both symptomatic and asymptomatic abnormalities, and discography is controversial as a standalone test

Background and Rationale

Discography is an invasive intradiscal diagnostic procedure in which contrast medium is injected into an intervertebral disc to reproduce a patient’s pain and to visualize disc morphology. It is intended to help assess whether a disc is the likely source of symptoms and to inform surgical decision-making; however, the technique is controversial and the literature does not consistently demonstrate that discography predicts surgical outcomes. There is also evidence suggesting the procedure may accelerate disc degeneration.

Lumbar discography is considered not medically necessary for members of Centene‑affiliated health plans because available evidence indicates the procedure is not safe or effective. Requests for lumbar discography will not meet medical necessity criteria under this policy.

Definitions

Discography (definition & clinical purpose)

DefinitionDiscography is an invasive intradiscal diagnostic technique in which contrast medium is injected into an intervertebral disc to reproduce pain and visualize disc morphology.

PurposeUsed as a screening tool to reproduce a patient’s pain, visualize disc morphology, and help determine appropriateness of surgical intervention.

Procedure detailIn lumbar discography, contrast medium is injected into a lumbar intervertebral disc thought to be the cause of low back pain; injection pressures are also considered when interpreting results.

Imaging componentThe technique uses imaging guidance to target the disc and document contrast distribution and disc morphology.

Clinical intentIntended to assess symptomatic disc degeneration and to assist in surgical planning when discogenic pain is suspected.

OpenPayer