If finalized, the policy would not consider lumbar spinal fusion medically necessary when performed with initial primary laminectomy/discectomy for nerve root decompression or spinal stenosis without documented spondylolisthesis or when performed with multi-level degenerative disc disease, and procedures for those indications would not be covered.
The policy would consider lumbar spinal fusion medically necessary and covered when select rarely present criteria were met.
Ara Deukmedjian, MD, neurosurgeon and CEO of Deuk Spine Institute in Melbourne, Fla., had this reaction: “[It’s] very disappointing. The proposed change will clearly have a negative impact on patient care. Patients will no longer have access to appropriate care and pain relief when multi-level fusion is indicated. The denial of these procedures by payors began in North Carolina, and is spreading across the United States at an alarming rate. Our own practice in Florida has seen an increasing number of authorization denials for medically necessary lumbar fusion. But now, it’s policy in the making: Florida Medicare will no longer cover multi-level lumbar fusion for symptomatic degenerative disc disease. Disguised as a draft policy by CMS and the Florida contractor, First Coast, the decision now looms as a tsunami threatening the ability of competent spine surgeons to appropriately care for their patients’ back pain.”
Draft LCDs are works in progress available for public review and not necessarily a reflection of the current policies or practices, according to a disclaimer on the report. Comments on the draft close on July 18.
Comments can be sent to Medical Policy – Medical.Policy@fcso.com
532 Riverside Ave
ROC 19T
Jacksonville, FL 32202
View the draft of the Local Coverage Determination for Lumbar Spinal Fusion for Instability and Degenerative Disc Conditions (DL32074).
Related Articles on Spinal Fusions:
Spinal Fusion’s Place in the Future: 9 Points on Fusion Efficacy and Coverage
5 Points on Lowering the Cost of Spinal Fusion
Spinal Fusion Reimbursement: Q&A With NASS President Dr. Greg Przybylski
