ADRSupport Community - BCBS - Florida outlines definition of medical necessity for Cervical Total Disc Repla

This may be common information, but the first time I've seen this.
It is very encouraging for me as I am in the appeal process with TriCare.

Follow the link below for the entire text.

http://mcgs.bcbsfl.com/?doc=Artifici...ertebral Discs

In their new Medical Policy Guideline (as of Oct 11), BCBSF Medical Coverage Guideline was revised regarding Artificial Intervertebral Discs.

In a change from their Jan 2009 policy letter, BCBSF now holds the opinion that cervical TDR at a single level meets the definition of medical necessity if patients are between 18-65, have exhaused all non-operative treatment options (listed), DDD at one level from C3-C7 and compression lesion documented by MRI, CT ext.

In this new policy guideline, some CPT codes for cervical TDR still carry the note of "investigational". However, BCBSF dropped the note of "investigational from codes 22856, 22861 and 22864.

Exceptions listed include the Federal Employee Program, State Account Org and Medicare Advantage.

This Medical Coverage Guidline was approved by the BCBSF Medical Policy & Coverage Committee on Sep 22, 2011 and the document released has a copyright of Jan 2012

I hope this is helpful to others.

Tim