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.
X-STOP® is an implantable device intended to limit motion of vertebrae.
The X-STOP® interspinous process device is not covered at this time. L&I reviewed the scientific literature addressing this device and determined there is not sufficient evidence of safety and efficacy.
X-STOP® is an implantable device intended to limit motion of vertebrae (bones in the spine). Reduction of vertebral motion may prevent pain caused by compression of blood vessels and nerves in or near the spine. X-STOP is intended for use in persons 50 years of age and older with moderate impairment from a condition called neurogenic intermittent claudication (NIC).
Potential benefits of the device include:
- Less invasive than some surgical alternatives,
- Reversible procedure, and
- Implantation can be completed without general anesthetic for most patients.
L&I reviewed the available scientific literature and determined there is not sufficient evidence showing short-term or long-term safety and effectiveness for the intended use. L&I will review new scientific information relevant to this policy as it becomes available.
Specific CPT™ billing codes for X-STOP became effective on January 1, 2007. These codes are not paid by the insurer.