From implants to surgical techniques, national and commercial payers are updating their policies to expand access to spine care.
Here are six key moves to know since the start of 2023:
1. Aetna updated its Clinical Policy Bulletin saying FDA-approved total disc implants are "medically necessary" for treating lumbar degenerative disc disease at one level under certain criteria. Criteria for coverage include being 18 to 60 years old, having failed conservative treatment for at least six months, and confirmation of single-level disease through imaging.
2. Cigna began covering Relievant Medsystems' Intracept procedure for the treatment of vertebrogenic low back pain. Intracept also earned a positive coverage policy from Anthem Blue Cross Blue Shield.
3. Cigna implemented a positive coverage policy for Intrinsic Therapeutics' Barricaid bone-anchored annular closure device.
4. Premia Spine earned CMS' New Technology Add-on Payment for the TOPS system, in October. This provides up to an additional $11,375 beyond the standard DRG payment for the procedure.
5. The largest commercial payer in Washington state implemented coverage for Centinel Spine's Prodisc L implant. Centinel Spine also earned coverage from a large commercial payer in Tennessee for one- and two-level lumbar disc replacement.
6. Carlsmed's aprevo spine implants earned favorable payment coverage from Medicare, the devicemaker said Aug. 5.