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Indicates Non-Covered Service
Anterior Cervical Decompression with Fusion (ACDF) - Single Level (elective)
Anterior Cervical Decompression with Fusion (ACDF) - Multiple Level (elective)
Cervical Artificial Disc Replacement - Single or Two Level (elective)
-Humana-
Cervical Fusion for Treatment of Axial Neck Pain (elective)
Cervical Posterior Decompression (elective)
Cervical Posterior Decompression with Fusion – Multiple levels (urgent/emergent)
Cervical Posterior Decompression with Fusion - Single Level (elective)
Cervical Spinal Fusion
Cervical Laminectomy Other Than for Herniated Disc
Cervical Laminectomy for Herniated Disc
Cervical Laminoplasty
Cervical Spine Indications for Referrals
Cervical
Spine Procedures
Chiari Malformation Decompres-sion Surgery
Cluster & Migraine Headache: Nonsurgical Management
-Aetna-
Complex Regional Pain Syndrome (RSD)
Deep Brain Stimulation for Essential Tremor & Parkinson's Disease
Selective Dorsal Rhizotomy for Cerebral Palsy
Endoscopic & Percutaneous Lysis of Epidural Adhesions
Epidural Lysis of Adhesions
-Anthem-
-Humana-
-FloridaBlue-
-Humana-
Electrical Bone Growth Stimulation: Noninvasive
Facet
Arthroplasty
-Humana-
Growing Rods for Spinal Surgery
Hydrodissection
-Humana-
Implantable Infusion Pump for Pain & Spasticity
Implantable Infusion Pump for the Treatment of Chronic Intractable Pain Opioid
Drugs
Implantable Infusion Pump for the Treatment of Chronic Intractable Spasticity
Interspinous & Interlaminar Stabilization/Distraction (Spacers) & Fixation (Fusion) Devices
-Cigna-
-Humana-
Interspinous Process Decompression
Intraoperative Neurophys-
iology
Monitoring
Laminectomy, Laminotomy, Facetectomy, & Foraminotomy (elective)
Laser Interstitial Thermal Therapy
Laser Interstitial Thermal Therapy
Lumbar Discectomy/Microdiscec-tomy (elective)
Lumbar Spinal Fusion
-FloridaBlue-
Lumbar Spine Indications for Referral
Lumbar Spinal Procedures
Lumbar Total Disc Arthroplasty (TDA)
Multi-level Lumbar Fusions with or without decompression (elective)
Occipital Nerve Injections & Ablation (Including Occipital Neuralgia & Headache)
-UHC-
Occipital Nerve Stimulation
-FloridaBlue-
Surgical Treatment of Occipital Neuralgia & Headache
-FloridaBlue-
Optic Nerve Decompression Surgery
Osteopathic Manipulative Treatment
Pedicle Screws for Spinal Fixation & Intervertebral Body Fusion Devices
Percutaneous Vertebral Augmentation (Vertebral Augmentation) (Formerly Kyphoplasty)
Peripheral Nerve Stimulation & Peripheral Nerve Field Stimulation
Repeat Lumbar Spine Fusion Operations (elective)
Scoliosis
& Spinal Deformity
Spasticity Management
Cigna-
-Humana-
Minimally invasive Surgical (MIS) Fusion of the Sacroiliac (SI) Joint (L36406)
Selective Peripheral Denervation (Bertrand Procedure)
Single Level Lumbar Fusion with or without decompres-sion (elective)
-FloridaBlue-
-Medicare-
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