Cervical Spinal Fusion for Degenerative Disc Disease

Coverage Decision

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:

  1. Patients with signs and symptoms of radiculopathy; and
  2. Advanced imaging evidence of corresponding nerve root compression; and
  3. Failure of conservative (non-operative) care.

Cervical Spinal Fusion is not a covered benefit for neck pain without evidence of radiculopathy or myelopathy.

Please go to: http://www.lni.wa.gov/ClaimsIns/Files/OMD/MedTreat/ReviewCriteriaforCervicalSpinalFusion.pdf for review criteria of cervical spinal fusion for Degenerative Disc Disease.

Background Policy Information

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.

Complete information on this HTCC determination is available here:
http://www.hta.hca.wa.gov/degenerative_disc_disease.html

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. Please contact Qualis Health in any of the following ways:

  • Phone: 800-541-2894 (toll free) or 206-366-3360
  • Fax: 877-665-0383 (toll free) or 206-366-3378
For Crime Victims:

Please contact the nurse consultant by one of the following modes of transmission: fax to 360-902-5333 or call 360-902-4896.

For Self-Insured Claims

For self-insured claims, contact the self-insured employer (SIE) or their third party administrator (TPA). For a list of SIE/TPAs, go to:
http://www.lni.wa.gov/ClaimsIns/Insurance/SelfInsure/EmpList/FindEmps/Default.asp

Billing Codes
Primary CPT ® Code
22551 - Arthrodesis, 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

Health Care Authority's Health Technology Assessment Program site.


For more information:
Contact information.

End of main content, page footer follows.

Access Washington official state portal

© Washington State Dept. of Labor & Industries. Use of this site is subject to the laws of the state of Washington.