Discography: Insurance Company Positions

Below are the positions of some major insurance companies on their coverage of discography as used to evaluate vertebral disc abnormality:

Aetna:

Aetna considers lumbar provocative discography medically necessary for evaluation for disc pathology in persons with persistent, severe low back pain (LBP) and abnormal interspaces on magnetic resonance imaging (MRI), where other diagnostic tests have failed to reveal clear confirmation of a suspected disc as the source of pain, and surgical intervention is being considered.

Aetna considers lumbar provocative discography experimental and investigational for all other indications because its effectiveness for indications other than the ones listed above has not been established.

Aetna considers cervical and thoracic provocative discography experimental and investigational because there is insufficient evidence to support their effectiveness.

Aetna considers functional anesthetic discography (involving injection of anesthetic directly into the disc) experimental and investigational because there is insufficient evidence to support its clinical utility.

Anthem Blue Cross/Blue Shield:

Cervical and thoracic discography are each considered investigational and not medically necessary for all indications.

Discography of the lumbar vertebrae is considered medically necessary for the evaluation of low back pain with or without lower extremity pain when ALL of the following are present:

• Pain is unrelenting and has persisted for an extended period of time (at least 3 months); AND
• Pain has not responded to conservative treatment measures (i.e., NSAIDs, physical therapy, etc.); AND
• Noninvasive diagnostic studies have failed to provide sufficient diagnostic information regarding the origin of pain; AND
• There is no evidence of contraindications such as severe spinal stenosis resulting in intraspinal obstruction, infection, or predominantly psychogenic pain.

In addition to those listed above, at least ONE of the following indications must be present:

• A high index of suspicion for discogenic pain and the pain is severe enough to consider surgical intervention, OR
• For failed back surgery individuals, to distinguish between painful pseudoarthrosis or a symptomatic disc in a posteriorly fused segment.