CurrentCentenePolicy CP.MP.115

Discography

Defines Centene's coverage stance and clinical rationale for lumbar, cervical, and thoracic discography for members/enrollees; applies to services submitted to Centene-affiliated health plans and informs medical necessity determinations for these procedures.

Policy Summary

PayerCentene

PolicyDiscography

Policy CodePolicy CP.MP.115

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionDocument indication, prior imaging that did not confirm the source of discogenic pain, and that surgery is being considered when submitting requests.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not medically necessarylumbar stance

Insufficient evidencecervical/thoracic stance

62290–72295codes referenced

Split from CP.MP.63history

Coverage Determinations for Discography

Not Medically Necessary — Lumbar Discography

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

Policy statement I

Insufficient Evidence — Cervical/Thoracic Discography

Cervical and thoracic discography: 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 not appropriate diagnostic or screening tools for cervical and thoracic pain because the published literature lacks validation studies and controlled outcome data. The evidence base is limited by a paucity of studies and the available studies are generally low quality, leading to an insufficient evidence determination for these procedures.

Lumbar discography is considered not medically necessary because evidence indicates the procedure is not safe or effective. The background literature describes lumbar discography as controversial: while some groups report associations between provoked pain and imaging findings, there are conflicting data about its reliability and utility to predict surgical outcomes. Additionally, prospective data have shown discography may accelerate disk degeneration (new herniations, loss of disc height and signal), supporting the policy judgment that harms and uncertain benefit make lumbar discography clinically inappropriate.

Policy Summary

PayerCentene

PolicyDiscography

Policy CodePolicy CP.MP.115

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionDocument indication, prior imaging that did not confirm the source of discogenic pain, and that surgery is being considered when submitting requests.

SourceLink

On This Page

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Provider Requirements and Administrative Actions

Prior Authorization

Prior Authorization Required

Prior authorization is required for discography procedures. Submit a prior authorization request before performing discography to ensure coverage determination. Relevant CPT codes to reference on the prior authorization and claim include: 62290, 62291, 62292, 72285, and 72295.

CPT 62290 — Injection procedure for discography, each level; lumbar
CPT 62291 — Injection procedure for discography, each level; cervical or thoracic
CPT 62292 — Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar
CPT 72285 — Discography, cervical or thoracic, radiological supervision and interpretation
CPT 72295 — Discography, lumbar, radiological supervision and interpretation

Documentation Required

Key Definitions

Discography — definition of the procedure

Anatomic focusPerformed on lumbar, cervical, or thoracic intervertebral discs depending on the clinical indication and level(s) under evaluation.

Discogenic pain context — definition and clinical context

Clinical contextDiscogenic pain refers to chronic low back pain thought to originate from intervertebral disc pathology after other potential sources of lumbar pain have been excluded and when surgery is being considered.

Controversy and limitationsLumbar discography is controversial due to mixed evidence on reliability and accuracy, absence of a definitive gold-standard, and potential to provoke pain in individuals without prior back pain.

Potential harms and outcomesProspective data suggest discography may accelerate disk degeneration (new herniations, loss of disc height and signal intensity); evidence is insufficient to demonstrate it predicts successful surgical outcomes.

Conservative Care and Exclusion of Other Sources

Other potential sources of lumbar pain must be excluded and surgical consideration documented

Contextual background: when considered clinically (noting policy stance above), other potential sources of lumbar pain should be excluded and documentation should show surgical consideration.

Pre-test evaluation: Other potential sources of lumbar pain have been excluded (e.g., evaluation and imaging to assess non-discogenic causes).

Background context for discogenic pain evaluations

Surgical consideration documented: Documentation that lumbar surgery is being considered is present in the medical record.

Background context for discography use

OpenPayer

Discography

Coverage Determinations for Discography

Procedure Codes

Provider Requirements and Administrative Actions

Clinical Background

Key Definitions

Conservative Care and Exclusion of Other Sources

Imaging and Diagnostic Requirements

Not Covered / Not Medically Necessary Services

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