All PlansCoverageMedium impact
Artificial Intervertebral Discs
Regence BlueShield·Orthopedics, Neurosurgery·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 16, 2026
Summary
New medical policy SUR127 establishes comprehensive coverage criteria for artificial intervertebral disc replacement procedures in cervical and lumbar spine, effective April 1, 2026. The policy defines specific medical necessity requirements, patient eligibility criteria, contraindications, and required documentation for both cervical (single or two-level) and lumbar (single-level only) disc replacements.
Action Required
Before April 1, 2026: Clinical and billing teams must review all artificial intervertebral disc replacement cases against new policy criteria sections I-VI. Update prior authorization requests to include required documentation: History and Physical/Chart Notes, symptom documentation, MRI/CT imaging with findings, planned disc placement levels, conservative therapy documentation, and specific device names. Ensure providers document all eligibility criteria including FDA approval status, patient age restrictions, specific spinal levels, failed conservative therapy (minimum 6 weeks), and absence of contraindications. Cases not meeting criteria will be considered not medically necessary or investigational.