Artificial Cervical Intervertebral Disc - (Effective Date - 2026-10-15) 7.01.80

By October 15, 2026: Billing and authorization teams must implement the following workflow changes: (1) Establish prior authorization process in billing software requiring ALL documentation outlined in policy 7.01.80 before approving artificial cervical intervertebral disc procedures; (2) Create pre-authorization checklist for providers documenting: patient age ≥18, FDA-approved device confirmation, specific level (C3-C7) and single/two-level contiguity, absence of prior surgery at level, clinical symptoms matching radiculopathy or myelopathy criteria, physical exam findings per policy, failed conservative treatment (≥2 modalities for 6 weeks minimum), imaging confirmation of neural compression, instability assessment via X-ray, and behavioral health clearance; (3) Update encounter forms and EMR templates to require providers to document all required criteria at time of request; (4) Configure billing system to require submission of MRI/CT imaging reports, plain X-ray studies with flexion/extension views, physical exam documentation, and records of conservative treatment attempts before claim processing; (5) Train all authorization staff on distinction between radiculopathy criteria (requires BOTH significant daily pain AND unremitting radicular pain) and myelopathy criteria (requires ANY listed symptoms); (6) Establish rejection workflow for claims missing required documentation or not meeting criteria. Failure to implement prior authorization will result in claim denials and potential overpayments requiring recovery.