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Artificial Disc Replacement: Insurance Company Positions

Below are the positions on artificial disc replacement coverage that some of the major insurance companies in the U.S. have taken. If you have any questions on your coverage eligibility, contact us or speak to your insurance company representative directly.

Aetna:

Aetna considers FDA-approved prosthetic intervertebral discs (e.g., the Charité Artificial Disc and the ProDisc-L Total Disc Replacement) medically necessary for spinal arthroplasty in skeletally mature persons with symptomatic (e.g., back and/or leg pain) lumbosacral degenerative disc disease by radio graphic studies (e.g., CT, MRI, x-rays) at one level from L3 to S1, and who have failed at least six months of conservative management.

Aetna considers FDA-approved prosthetic intervertebral discs (e.g., the Prestige Cervical Disc, ProDisc-C Total Disc Replacement, and the Bryan Cervical disc) medically necessary for the treatment of skeletally mature persons with symptomatic (e.g., radicular neck and/or arm pain and/or functional/neurological deficit) cervical degenerative disc disease or herniated disc at one level from C3 to C7, confirmed by radiographic studies (e.g., CT, MRI, x-rays), and who have failed at least 6 weeks of conservative management.

Aetna considers the use of hybrid fusion with artificial disc replacement experimental and investigational for the management of back pain, spinal disorders, and all other indications.

United Healthcare:

Cervical artificial total disc replacement is proven for the treatment of single level degenerative disc disease in skeletally mature patients when used with FDA approved implants. (FDA approved artificial disc include the Pro-Disc C, Prestige Cervical Disc, and Bryan Cervical Disc.

Lumbar artificial total disc replacement is unproven for the treatment of single or multiple level degenerative disc disease in skeletally mature patients.

CIGNA:

CIGNA covers the surgical implantation of the Charité® or ProDisc®-L lumbar intervertebral disc (IVD) prosthesis for chronic, unremitting, discogenic low back pain and disability secondary to single-level degenerative disc disease (DDD) as medically necessary in a skeletally mature individual when ALL of the following criteria are met:

  • The unremitting low back pain and disability described has been refractory to at least six consecutive months of standard medical and surgical management (e.g., exercise, analgesics, physical therapy, spinal education).
  • Single-level disc degeneration has been confirmed on complex imaging studies (i.e., computerized tomography [CT] scan, magnetic resonance imaging [MRI]).
  • The planned implant will be used in the L4-S1 region if Charité or the L3-S1 region if ProDisc®-L.

CIGNA does not cover the surgical implantation of any of the following because they are considered experimental, investigational or unproven:

  • A Charité or ProDisc®-L lumbar intervertebral disc prosthesis when any of the following apply:
    • The planned procedure includes the combined use of a prosthesis and spinal fusion
    • Simultaneous multilevel implantation is planned.
    • The implant will be inserted outside of the L4-S1 region (Charité) or outside of the L3-S1 region (ProDisc®-L).
    • The individual has osteopenia or osteoporosis (T-score <-1.0).
    • The individual has a history of prior lumbar fusion.
    • There is evidence on imaging studies of ANY of the following:
      • Degenerative spondylolisthesis of Grade 2 or greater
      • Infection
      • Multilevel degenerative disc disease
      • Nerve root compression or spinal stenosis
      • Pars interarticularis defect with either spondylolysis or isthmic spondylolisthesis
      • Scoliosis
      • Severe facet joint arthrosis
      • Spinal fracture
      • Tumor
  • A lumbar disc prosthesis other than Charité or ProDisc®-L


CIGNA does not cover the implantation of the cervical intervertebral disc prosthesis (e.g., PRESTIGE™ ST, ProDisc™-C, BRYAN® Cervical Disc) for any indication because it is considered experimental, investigational, or unproven.

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