Hi Doug,
Sorry you are here but you are among friends. When you get a chance, check out the advanced search feature:
https://www.adrsupport.org/forums/search.php
Search for Ritter Lang. You may be surprised.
If you need a fusion, it will likely be covered here in the U.S. But I have been startled to see some rejections from this procedure that has been practiced for over 100 years!