Total Artificial Disc Replacement Spine Nj Cs
State-specific UnitedHealthcare medical policy (New Jersey) defining medical necessity criteria, coverage limitations, and applicable coding for cervical and lumbar total artificial disc replacement (TADR/TDR), including indications, exclusions (hybrid surgeries and multilevel lumbar), documentation expectations, and referenced InterQual criteria.
Revised coverage rationale (03/01/2026) clarifying cervical and lumbar TADR/TDR medical necessity criteria and specifying unproven indications including hybrid and multilevel lumbar procedures.
Revised cervical coverage language to specify one- or two-level contiguous disease (C3-C7), skeletal maturity, radiculopathy/myelopathy, performance at all symptomatic contiguous levels (up to two), and InterQual criteria requirement.
Added coverage statement that cervical artificial disc removal or replacement with an FDA-approved (one or two-level) device is medically necessary for implant failure after prior disc replacement.
Revised lumbar coverage language to state lumbar TADR is medically necessary for single-level disease with symptomatic intractable discogenic low back pain and InterQual criteria met.
Clarified lumbar TADR is unproven and not medically necessary when performed with existing lumbar fusion at another level, as part of the same surgical plan (hybrid), or when performed at more than one spinal level.
Added and updated definitions to support coverage criteria (Contiguous Levels, Hybrid Cervical/Lumbar Surgery, Radiographically Confirmed Complete Arthrodesis, Skeletally Mature).
Coverage Summary
Medical-Necessity Criteria
Cervical Total Artificial Disc Replacement — Medically Necessary
Cervical total artificial disc replacement (TADR) is proven and medically necessary when ALL of the following are present and InterQual criteria are met:
ALL of the following
- An FDA-approved prosthetic intervertebral disc is utilized.
- Individual diagnosed with only one or two contiguous levels of cervical degenerative disc disease (C3-C7).
- Skeletally mature individual with radiculopathy and/or myelopathy.
- The arthroplasty will be performed at all symptomatic contiguous levels (up to two levels between C3-C7).
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