Spinal Fusion and Decompression (for Kentucky Only)
Summary
UnitedHealthcare Community Plan of Kentucky revised its spinal fusion and decompression medical policy effective November 1, 2026, adding new clinical coverage criteria references to InterQual guidelines, introducing six new clinical definitions, and clarifying that staged/serial procedures for multisite spinal pathology and certain procedures (dynamic stabilization, facet joint replacement, isolated facet joint fusion, vertebral joint implants) are not medically necessary. Billing teams must update their medical necessity determination processes to align with the new InterQual criteria and identify claims that may be subject to denial under the updated non-covered procedures list.
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