5 spine, orthopedic procedures securing payer coverage this year

Orthopedic

While payer coverage in the orthopedic and spine industry is still considered spotty by surgeons, some procedures have made strides in 2023. Since the beginning of the year, five new procedures have secured coverage from major payers. 

The five notable procedures securing payer coverage this year: 

1. Relievant Medsystems' Intracept spine procedure earned a positive coverage policy from Anthem Blue Cross Blue Shield in September, expanding access for the procedure to more than 36 million patients.

2. Centinel Spine's Prodisc device earned positive coverage by a large commercial payer in Michigan on Sept. 1. The coverage policy includes one- and two-level lumbar disc replacement using Centinel Spine's Prodisc L system and will affect more than 5.8 million patients. 

3. Cigna began covering Relievant Medsystems' Intracept procedure for the treatment of vertebrogenic low back pain on June 15, impacting around 19 million Americans. 

4. ZimVie's vertebral body tethering system for scoliosis received a positive medical policy decision from Highmark in March. Under this policy, Blue Cross Blue Shield Association will cover ZimVie's technology. It went into effect Jan. 30 for Highmark and March 6 for BCBS North Dakota. ZimVie's Tether device is a non-fusion scoliosis system and is the first FDA-approved device for VBT.

5. In March, access to Centinel Spine's Prodisc L lumbar total disc replacement system expanded as Aetna updated its guidelines to include one-level lumbar total disc replacement in its coverage. An additional 22 million individuals will now be covered for the procedure.




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