Artificial Lumbar Intervertebral Disc - (Effective Date - 2026-10-15) 7.01.63

By October 15, 2026: Billing team must implement prior authorization requirement for all artificial lumbar intervertebral disc (total disc arthroplasty) procedures submitted to Excellus BlueCross BlueShield. UPDATE SYSTEM: Configure billing software to flag these claims for prior auth review. UPDATE WORKFLOWS: Create pre-authorization checklist requiring providers to submit: (1) CPT/ICD-10 codes and specific lumbar levels; (2) Detailed documentation of non-surgical treatment type, duration, frequency, and response for minimum 6 consecutive months; (3) Advanced imaging reports (CT/MRI) with radiologist interpretation; (4) Confirmation patient meets ALL criteria in Policy Statement I (age 18-60, single-level only, no facet ankylosis, moderate-to-severe DDD at operative level only, concordant symptoms, functional impairment, unmanaged mental health disorders absent). UPDATE ENCOUNTER FORMS: Add checkboxes for medical necessity documentation. PROVIDER COMMUNICATION: Notify orthopedic and spine surgery providers of the 10 specific contraindications (spondylolisthesis >3mm, spinal stenosis, spondylolysis, scoliosis >11 degrees, osteoporosis, autoimmune disorders, etc.) that will result in claim denial. CONSEQUENCES: Claims submitted without complete prior authorization documentation will be denied. Claims for patients outside age range (18-60), multi-level procedures, or with any documented contraindications will be denied.