CMS Proposes Denial of Coverage for Artificial Disc Replacement

June 8, 2007
by: Stephanie

The Centers for Medicare and Medicaid Services has proposed that lumbar artificial disc replacement “is not reasonable and necessary for the Medicare population over sixty years of age.”

The proposal is largely based on the known risk factors in the event that the surgery would need to be revised and the lack of data for individuals over age 60. The CMS had previously issued a non-coverage decision for just the Charite artificial disc, but since then the Prodisc has been approved and a number of other discs are in various stages of development and clinical trials. This proposal would expand the coverage to include all lumbar artificial discs. The proposal leaves coverage decisions for individuals under age 60 up to local Medicare agencies.

While few people over age 60 actually are indicated for artificial disc replacement, CMS coverage decisions do have influence over insurance company decisions about coverage for the artificial discs.

This is a proposed determination at this point not a final decision. Before issuing a final determination CMS is requesting comments from the public.

Posted by: Stephanie