Total Artificial Disc Replacement for the Spine
Defines medical necessity, limitations, and coding for cervical and lumbar total artificial disc replacement (TADR/TDA) and related hybrid surgeries; applies to UnitedHealthcare members except where state-specific policies override.
Revised language to indicate cervical total artificial disc replacement is proven and medically necessary when all criteria and InterQual are met, with specifics on FDA-approved device use and limits to one or two contiguous levels (C3-C7).
Clarified that cervical TADR after prior cervical spinal fusion can be medically necessary if radiographically confirmed complete arthrodesis and other criteria are met.
Defined that cervical TADR performed at one level combined with cervical fusion at another level (hybrid cervical surgery) is unproven and not medically necessary.
Specified lumbar TDR is proven and medically necessary for single-level lumbar degenerative disc disease when InterQual criteria are met, and listed circumstances where lumbar TDR is unproven/not medically necessary (hybrid surgery, multiple levels, existing fusion at another level).
Updated medical records documentation requirements to add relevant imaging and diagnostic testing including documentation of instability and additional items for removal/replacement cases.
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