Artificial Cervical Intervertebral Disc - (Effective Date - 2026-10-15) 7.01.80
Summary
Excellus BlueCross BlueShield medical policy 7.01.80 covers artificial cervical intervertebral disc implants for radiculopathy or myelopathy, with a current effective date of October 15, 2026. Initial implants are considered medically appropriate when the individual is at least 18 years old, the planned implant is for a single level or contiguous two-level replacement at C3-C7 following discectomy, and the listed symptom, exam, imaging and non-operative treatment criteria are all met, including less than clinically meaningful improvement with at least two of the listed non-operative treatments unless contraindicated. Cervical total disc arthroplasty for adjacent segment disease secondary to a prior cervical total disc arthroplasty is considered medically necessary when its listed criteria are met, and it is considered not medically necessary when performed for degenerative disc disease as the sole indication or after a failed cervical total disc arthroplasty at the same level.
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