BCBS of Texas

[jchebert1979]

I have BCBS of Texas (although I live in Louisiana) and this is directly from their site.

Coverage:

Cervical Disc Replacement

Artificial intervertebral cervical discs may be considered medically necessary when ALL of the following criteria are met:

Disc has the approval of the U.S. Food and Drug Administration (FDA); AND
Disc will be used for single-level reconstruction (C3-C7) following discectomy; AND
Patient has intractable radiculopathy and/or myelopathy due to herniated disc or osteophyte formation; AND
Patients has failed at least six weeks of conservative therapy; AND
Symptomatic nerve root and/or spinal cord compression documented by ALL the following:
Neck and/or arm pain; and
Functional and/or neurological deficit; and
Radiographic studies (e.g., Computed Tomography (CT), Magnetic Resonance Imaging (MRI), x-rays, etc.).
Artificial intervertebral cervical discs are considered experimental, investigational and unproven for all other indications, including multi-level use, whether done simultaneously or at different times.

Lumbar Disc Replacement

Artificial intervertebral lumbar discs are considered experimental, investigational and unproven.


This is the link to their policy. It is interesting because it even gives information that with fusion there is an increased risk of degeneration of the adjacent levels. I will be trying to get pre-approval this week. I will definately let the board know how it goes.

BCBSIL/Provider Medical Policies on Fyiblue

Just agree to terms and type in artificial disc in the search engine.