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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)
-Aetna-
-Anthem-
Cervical Posterior Decompression (elective)
Cervical Posterior Decompression with Fusion – Multiple levels (urgent/emergent)
Cervical Posterior Decompression with Fusion - Single Level (elective)
-FloridaBlue-
-Aetna-
-Cigna-
-Humana-
-Aetna-
-Medicare-
-Aetna-
-Anthem-
-Cigna-
-Humana-
Lumbar Laminectomy
-Anthem-
-Anthem-
Lumbar Fusion & Treatment of Spinal Deformity (including Scoliosis & Kyphosis)
Referral
Indications
Lumbar Spine
-Anthem-
Lumbar Spinal Procedures
-FloridaBlue-
Lumbar Total Disc Arthroplasty (TDA)
Multi-level Lumbar Fusions with or without decompression (elective)
-Anthem-
-Medicare-
-UHC-
Percutaneous Vertebroplasty, Kyphoplasty, & Sacroplasty
-FloridaBlue-
-FloridaBlue-
-Medicare-
-Anthem-
-Cigna-
-FloridaBlue-
Thoracoscopic Sympathectomy
-Aetna-
Indicates Non-Covered Service
Automated Percutaneous Discectomy, Laser Discectomy, Percutaneous Endoscopic Discectomy, & DISC Nucleoplasty
AxiaLIF
-Aetna-
-FloridaBlue-
Discography
-UHC-
Dynamic Spinal Stabilization Devices
-Humana-
Epidural Lysis of Adhesions
Epiduroscopy
-UHC-
-Humana-
-UHC-
Facet
Arthroplasty
-FloridaBlue-
-Humana-
Interspinous & Interlaminar Stabilization/Distraction (Spacers) & Fixation (Fusion) Devices
Intradiscal Procedures
-Aetna-
-Cigna-
-FloridaBlue-
-Humana-
Percutaneous Intradiscal Electrothermal Annuloplasty, Radiofre-quency Annuloplasty, & Biacuplasty
Pulsed Radiofrequency
-Aetna-
-FloridaBlue-
Skeletal Analysis Systems
-Aetna-
Traction Devices – Cervical & Lumbar
-UHC-
-Aetna-
-Cigna-
-UHC-
Vertebral Axial Decompression
-Aetna-
Vertebral Body Tethering for Scoliosis
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