Total Artificial Disc Replacement Spine Tn Cs
Defines medical necessity criteria, limitations, and evidence summary for cervical and lumbar total artificial disc replacement (TADR/TDR) for Tennessee Medicaid and CoverKids, including indications, exclusions (hybrid surgery), prior fusion scenarios, device FDA-approval requirements, and applicable procedure codes.
Revised cervical coverage language to specify criteria for one- or two-level cervical TADR including requirement that device is FDA-approved and InterQual criteria are met.
Revised lumbar coverage language to indicate lumbar TDR is proven and medically necessary only for single-level disease with InterQual criteria met.
Removed reference link to the Medical Policy titled Interspinous Fusion and Decompression Devices (for Tennessee Only).
Added definitions for Contiguous Levels, Hybrid Cervical Surgery, Hybrid Lumbar Surgery, and Radiographically Confirmed Complete Arthrodesis; updated definition of 'Skeletally Mature'.
Updated Supporting Information, Clinical Evidence and References sections to reflect current literature (2024-2025).
Archived previous policy version CS121TN.U.
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