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Guideline Update for March 1, 2023
Blue Cross NC·NC · Orthopedics, Neurosurgery, PM&R (Physical Medicine & Rehab) +1 more·Medical Policy
Effective date
Mar 1, 2023
We identified it
Jun 16, 2026
Summary
Blue Cross NC updated spine surgery guidelines effective March 1, 2023, requiring 6 weeks of physical therapy plus another nonoperative treatment before cervical and lumbar spine procedures (unless patient has progressive neurologic deficits). This applies to diskectomy, fusion, and laminectomy procedures.
Action Required
Immediately: Providers must document 6 weeks of physical therapy plus additional nonoperative treatment before spine procedures for Blue Cross NC patients. Update EMR templates to capture required conservative treatment documentation. Verify exception criteria (progressive neurologic deficits) are clearly documented when bypassing 6-week requirement. Claims may be denied without proper conservative treatment documentation.