Coverage of Conditions and Treatments (Coverage Decisions)
Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.
List also available in PDF format.
See Treatment Guidelines and Resources for additional information.
Degenerative disc disease (DDD) of the cervical spine is a common phenomenon. Multiple treatment options are available for symptoms associated with DDD, including conservative measures; minimally-invasive procedures such as spinal injections and radiofrequency ablation; and surgical intervention. A common surgical procedure performed is spinal fusion, which involves removal of the damaged disc(s) and creation of a permanent connection across the vertebral space by means of a graft.
Cervical Spinal Fusion for Degenerative Disc Disease is a covered benefit with conditions. To receive the benefit, injured workers must have a cervical spine condition that is accepted on the claim, and meet the following conditions:
- Patients with signs and symptoms of radiculopathy; and
- Advanced imaging evidence of corresponding nerve root compression; and
- Failure of conservative (non-operative) care.
Cervical Spinal Fusion is not a covered benefit for neck pain without evidence of radiculopathy or myelopathy.
The State Health Technology Clinical Committee (HTCC) reviewed Cervical Spinal Fusion for Degenerative Disc Disease on March 22, 2013. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that Cervical Spinal Fusion for Degenerative Disc Disease is a covered benefit with conditions.
Review Criteria: Cervical Radiculopathy and Myelopathy (Modified December 3, 2015 to correct typos and formatting.)
Complete information on this HTCC determination is available here:
Implementation of this Determination
All requests for cervical spinal fusion require prior authorization.
For State Fund Claims
All requests are reviewed by L&I’s Utilization Review vendor Comagine Health.
Primary CPT Code
- 22551 - Arthodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2
- 22554 - Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace; cervical below C2
- 22600 - Arthrodesis, posterior or posterolateral technique, single level; cervical below C2