Spine-05

Musculoskeletal

Return to Surgery & Injections Main

Indicates Non-Covered Service

Anterior Cervical Decompression with Fusion (ACDF) - Single Level (elective)

Anterior Cervical Decompression with Fusion (ACDF) - Multiple Level (elective)

Back Pain - Invasive Procedures

-Aetna-

Cervical Decompression with or without Fusion

-Anthem-

Cervical

Fusion

-Cigna-

Cervical Fusion for Treatment of Axial Neck Pain (elective)

Cervical Disc Replacement

-Aetna-

-Anthem-

-Cigna-

Cervical Laminectomy for Herniated Disc

Cervical Laminoplasty

-Aetna-

Cervical Posterior Decompression (elective)

Cervical Posterior Decompression with Fusion – Multiple levels (urgent/ emergent)

Cervical Posterior Decompression with Fusion - Single Level (elective)

Referral Indications- Cervical Spine

Cervical

Spine Procedures

Coccygectomy & Treatments for Coccydynia

Discography-

Lumbar

-Aetna-

-FloridaBlue-

-Cigna-

Growing Rods for Spinal Surgery

Idiopathic Scoliosis Treatment

-Aetna-

Interspinous Process Decompression

-Medicare-

Intervertebral Disc Prostheses

-Aetna-

Laminectomy, Laminotomy, Facetectomy, & Foraminotomy (elective)

Laminectomy & Fusion

-Aetna-

Lumbar Laminectomy

-Anthem-

Lumbar Discectomy/Microdisc-ectomy (elective)

-Anthem-

Lumbar Spinal Fusion

-Medicare-

Lumbar Fusion & Treatment of Spinal Deformity (including Scoliosis & Kyphosis)

Referral

Indications

Lumbar Spine

Lumbar Spinal Procedures

-FloridaBlue-

Lumbar Total Disc Arthroplasty (TDA)

-Anthem-

-Medicare-

-Anthem-

-UHC-

Multi-level Lumbar Fusions with or without decompression (elective)

Pedicle Screws for Spinal Fixation & Intervertebral Body Fusion Devices

Percutaneous Vertebral Augmentation

-Anthem-

-Humana-

Percutaneous Vertebral Disc

& Vertebral Endplate Procedures

-Anthem-

Percutaneous Vertebroplasty, Kyphoplasty, & Sacroplasty

-FloridaBlue-

Recombinant Human Bone Morphogenetic Protein

-FloridaBlue-

Repeat Lumbar Spine Fusion Operations (elective)

Sacral

Nerve Stimulation

-FloridaBlue-

-Medicare-

Minimally Invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint (L36406)

Sacroiliac Joint Fusion

-Anthem-

-FloridaBlue-

Sacroiliac Joint Procedures

-Cigna-

Scoliosis

& Spinal Deformity

Single Level Lumbar Fusion with or without Decompression (elective)

Spinal Decompression Surgery

-Humana-

Surgery for Spinal Deformity

-FloridaBlue-

Surgical Treatment of Chest Wall Deformities

-Cigna-

Spinal Fusion Surgery-

All Levels

-Humana-

Thoracic Laminectomy and/or Thoracic Diskectomy & Fusion

Thoracic Spine Surgery

-UHC-

Thoracoscopic Sympathectomy

-Aetna-

Indicates Non-Covered Service

Automated Percutaneous Discectomy, Laser Discectomy, Percutaneous Endoscopic Discectomy, & DISC Nucleoplasty

AxiaLIF

-Aetna-

Discography

-UHC-

Dynamic Spinal Stabilization Devices

-Humana-

Epidural Lysis of Adhesions

-Humana-

-UHC-

Epiduroscopy

-UHC-

Facet

Arthroplasty

-FloridaBlue-

-Humana-

-FloridaBlue-

Interspinous & Interlaminar Stabilization/Distraction (Spacers) & Fixation (Fusion) Devices

Intradiscal Procedures

-Aetna-

Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofre-quency Annuloplasty, & Biacuplasty

Pulsed Radiofrequency

-Aetna-

Skeletal Analysis Systems

-Aetna-

Traction Devices – Cervical & Lumbar

-Aetna-

-Cigna-

Vertebral Axial Decompression

-Aetna-

-Cigna-

-FloridaBlue-

-UHC-

-FloridaBlue-

-Humana-

Vertebral Body Tethering for Scoliosis

-UHC-

• 0200T, 0201T, 0202T, 0219T, 0220T, 0221T, 0222T, 0274T, 0275T, 20930, 20931, 22100, 22101, 22102, 22103, 22110, 22112, 22114, 22116, 22206, 22207, 22208, 22210, 22212, 22214, 22216, 22220, 22222, 22224, 22226, 22510, 22511, 22512, 22513, 22514, 22515, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22585, 22586, 22590, 22595, 22600, 22610, 22612, 22614, 22630, 22632, 22633, 22634, 22800, 22802, 22804, 22808, 22810, 22812, 22818, 22819, 22830, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 22850, 22852, 22853, 22854, 22855, 22859, 22867, 22868, 22869, 22870, 22899, 27279, 27280, 62380, 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63081, 63082, 63085, 63086, 63087, 63088, 63090, 63091, 63101, 63102, 63103, 63170, 63172, 63173, 63185, 63190, 63191, 63197, 63200, 63250, 63251, 63252, 63265, 63266, 63267, 63268, 63270, 63271, 63272, 63275, 63277, 63280, 63282, 63285, 63286, 63287, 63290, 63300, 63301, 63302, 63303, 63304, 63305, 63306, 63307, 63308, 63076, 63077, 63078, 63081, 63082, 63085, 63086, 63087, 63088, 63090, 63091, 63101, 63102, 63103, 63170, 63172, 63173, 63185, 63190, 63191, 63197, 63200, 63250, 63251, 63252, 63265, 63266, 63267, 63268, 63270, 63271, 63272, 63275, 63277, 63280, 63282, 63285, 63286, 63287, 63290, 63300, 63301, 63302, 63303, 63304, 63305, 63306, 63307, 63308, 63650, 63655, 63663, 63664, 63685, 63688, 64999, C1816, C1820, C1822, L8679, L8680, L8682, L8685, L8686, L8687, L8688

™