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Lumbar Microdiscectomy - (Effective Date - 2026-10-15) 7.01.98
Effective date
Oct 15, 2026
Identified
Jul 16, 2026
Summary
Excellus BlueCross BlueShield's Lumbar Microdiscectomy policy (7.01.98) is effective October 15, 2026. The June 18, 2026 annual review added unremitting radicular pain into the lower extremity(ies) without concordant objective exam findings as a physical exam finding for radiculopathy. The policy also states that laser technique lumbar microdiscectomy is not medically necessary, and that percutaneous lumbar discectomy and annular repair devices such as the Barricaid Annular Closure Device are investigational.
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What to do
Action · 3 steps
01Already effective October 15, 2026: Billing team should confirm the current applicability of this policy for lumbar microdiscectomy claims.
02For radiculopathy, the physical exam findings must include ANY of the listed findings, including unremitting radicular pain into the lower extremity(ies) without concordant objective exam findings.
03Before submitting a spinal surgery prior authorization request, include the CPT codes, ICD-10 codes, and disc levels or motion segments involved, detailed documentation of the type, duration and frequency of non-surgical treatment and the response to each treatment, and written reports of the most recent advanced imaging interpreted by an independent radiologist.
Codes mentioned
6238063030630326303563042630446305663057632676327263277C9757S2350S2351D16.6D32.1D33.4M51.06M51.17M51.27M51.37M51.47M51.87M54.17
Original notice
Lumbar Microdiscectomy - (Effective Date - 2026-10-15) 7.01.98
excellusbcbs.com · Always check the source before changing claims.
Related changes
See all Excellus BlueCross BlueShield changes →Spine Procedures for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.126MediumEffective Jan 1, 2027 · Bone & Joints (Orthopedic)Intradiscal Procedures - (Effective Date - 2026-10-15) 7.01.112MediumEffective Oct 15, 2026 · Bone & Joints (Orthopedic)Lumbar Fusion - (Effective Date - 2026-10-15) 7.01.117HighEffective Oct 15, 2026 · Bone & Joints (Orthopedic)Lumbar Decompression - (Effective Date - 2026-10-15) 7.01.113MediumEffective Oct 15, 2026 · Bone & Joints (Orthopedic)Browse every Excellus BlueCross BlueShield change in the policy list
Related policy hubs
Excellus BlueCross BlueShield policiesNY policy changesOrthopedicsNeurosurgeryCode 62380Code 63030Code 63032Code 63035Code 63042Code 63044Code 63056Code 63057Code 63267Code 63272Code 63277Code C9757Code S2350Code S2351Code D16.6Code D32.1Code D33.4Code M51.06Code M51.17Code M51.27Code M51.37Code M51.47Code M51.87Code M54.17