CurrentmhnPolicy CP.MP.115

Discography

Policy governing coverage and medical necessity of discography (lumbar, cervical, thoracic) for members of health plans affiliated with Centene Corporation; affects providers requesting or performing discography for diagnostic evaluation of spinal pain.

Policy Summary

Payermhn

PolicyDiscography

Policy CodePolicy CP.MP.115

Change TypeNo material change

Effective Date

Next Review Date

Key ActionDo not request or perform lumbar discography for diagnostic purposes because it is considered not medically necessary; follow plan-specific prior authorization and documentation requirements if submitting claims.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not medically necessaryLumbar stance

Insufficient evidenceCervical/Thoracic stance

5 CPTsProcedure codes

AnnuallyReview frequency

Coverage Determinations and Criteria

Coverage determinations

Policy statements

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

from Policy/Criteria I

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

from Policy/Criteria II

Cervical and thoracic discography are considered controversial because there is an absence of validation and controlled outcome studies, with limited and low-quality literature. For evaluation of cervical or thoracic pain, discography is not an appropriate diagnostic or screening tool.

Lumbar discography is considered not medically necessary because the procedure has evidence indicating it is not safe or effective.

Policy Summary

Payermhn

PolicyDiscography

Policy CodePolicy CP.MP.115

Change TypeNo material change

Effective Date

Next Review Date

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Procedure Codes

Referenced CPT CodesCPT

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

Referenced CPT Codes (grouped neutral)CPT

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 Requirements, Prior Authorization and Documentation

Prior Authorization

Prior Authorization Required

Prior authorization is required for discography procedures. Submit a prior authorization request before performing lumbar, cervical, or thoracic discography.

Affected CPT codes: 62290, 62291, 62292, 72285, 72295

Documentation Required

Documentation Expectations

Maintain complete clinical documentation to support medical necessity and to justify the request. Documentation should include patient history, prior conservative treatments attempted and their outcomes, findings on noninvasive imaging (e.g., MRI), rationale for discography, targeted disc levels, and planned use of results for clinical decision-making (for example, surgical planning). Include procedure reports, injection pressures if measured, and radiologic interpretation when applicable.

Document prior nonoperative management and duration
Include relevant imaging reports (MRI, X-ray)
Record targeted levels and procedural details, including injection pressures and pain reproduction responses
Attach radiology supervision and interpretation reports (if performed)

Denial Risk

Denial Risk and Billing Impact

Providers should note that lumbar discography is considered not medically necessary per policy and may be denied if clinical documentation does not demonstrate clear justification; cervical and thoracic discography have insufficient evidence and may also be denied. Verify prior authorization approval before scheduling to avoid claim denials.

Denial risk: lumbar discography (policy: not medically necessary)
Denial risk: cervical and thoracic discography (insufficient evidence)

Definitions

Discography definition

DefinitionIntradiscal diagnostic technique using imaging and pain provocation to evaluate suspected discogenic pain by injecting contrast into intervertebral discs.

PurposeReproduce a patient’s pain, visualize disc morphology, and help determine appropriateness of surgical intervention.

MeasurementInjection pressures are recorded and considered when assessing whether findings suggest symptomatic disc degeneration.

InvasivenessInvasive procedure requiring intradiscal contrast injection under imaging guidance.

Lumbar discography definition

DefinitionContrast injection into a lumbar intervertebral disc to reproduce the patient's low back pain, assess disc morphology, and record injection pressures.

Clinical useUsed as a screening tool when a lumbar disc is suspected to be the source of chronic low back pain and to evaluate candidacy for surgical intervention.

Procedure detailPerformed under imaging guidance with contrast medium injected into the targeted lumbar disc level(s).

ConsiderationsResults interpreted using pain provocation, morphological imaging, and injection pressure data; clinical context and other causes of pain should be considered prior to use.

Conservative Treatment and Exclusion Requirements

Other possible sources of lumbar pain should be excluded prior to consideration of discography.

Covered when ALL of the following are met:

A: Other possible sources of lumbar pain have been excluded.

Clinical context: consider exclusion of non-discogenic causes prior to discography

B: Discography is being considered only as an evaluation when surgery is being considered for chronic discogenic low back pain.

Background: test considered in the setting of surgical consideration

C: Imaging (e.g., MRI, radiographs, myelography) has not identified a confirmed source of discogenic pain that would obviate the need for further provocative testing.

Imaging should not have confirmed source of discogenic pain

OpenPayer

Discography

Coverage Determinations and Criteria

Procedure Codes

Provider Requirements, Prior Authorization and Documentation

Definitions

Background

Conservative Treatment and Exclusion Requirements

Imaging Requirements

Not Covered / Not Medically Necessary