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Spine Procedures – Medicare Advantage Coverage Summary

Spine Procedures Page 1 of 9 UnitedHealthcare Medicare Advantage Coverage Summary Approved 11/16/2021 Proprietary Information of UnitedHealthcare. Copyright 2021 United HealthCare Services, Inc. UnitedHealthcare Medicare Advantage Cover a ge Summa r y Spine Procedures Policy Number: Approval Date: November 16, 2021 Instructions for Use Table of Contents Page Coverage Guidelines .. 1 Lumbar Spinal Fusion .. 1 Cervical Spinal Fusion .. 2 Thermal Intradiscal Procedures .. 2 Spinal Decompression and Interspinous Process Decompression Systems for the Treatment of Lumbar Spinal Stenosis .. 2 Arthrodesis, Pre-sacral Interbody Technique .. 3 Intra-facet Implants .. 3 Decompression Procedure, Percutaneous, of Nucleus Pulposus.

Spine Procedures Page 1 of 9 ... with or without back pain, and who have undergone at least 6 ... fluoroscopic, CT) with the assistance of contrast media to identify and monitor the compressed area via epidurogram. Covered Indications . I. Effective for services performed on or after January 9, 2014, the Centers for Medicare andMedicaid ...

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