The policy states that lumbar fusions are medically necessary for patients with degenerative disc disease at a maximum of two levels after the patient does not experience improvement with six months of conservative medical management. Elderly patients with DDD or patients with DDD at multiple levels may be considered candidates for fusion on a case-by-case basis, according to the policy.
This position goes against other guidelines — including coverage guidelines set forth by the Blue Cross Blue Shield of North Carolina — that say lumbar fusion is not necessary for patients with DDD.
The policy outlines several other conditions and situations where lumbar fusion is medically necessary as well as the situations where it isn’t medically appropriate.
Read the policy statement from SAS-International Society for the Advancement of Spine Surgery on lumbar fusions.
Related Articles on Spinal Fusions:
Spinal Fusion Reimbursement: Q&A With NASS President Dr. Greg Przybylski
Spinal Fusions Face an Uncertain Future
Spinal Fusion’s Place in the Future: 9 Points on Fusion Efficacy and Coverage
