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'They're on really thin ice': Why 1 insurer has drawn spine surgeons' ire

By Admin | April 15, 2022

Artificial disc replacement technology has advanced dramatically since the FDA approved it in 2004, and many surgeons laud the devices. However, it has its detractors.

Centinel Spine's Prodisc L is one popular device and is the only artificial disc approved in the U.S. for two-level replacement in the lumbar spine.

In recent months, the device has received strong support. The American Medical Association in November accepted a new CPT add-on code for the second level of lumbar total disc replacement procedures that will go into effect in 2023. In April, a third-party payer established coverage for one- and two- level lumbar disc replacement for patients in Utah and Idaho.

Another artificial disc, NuVasive's Simplify, was cleared in April 2021 by the FDA for two-level disc replacement in the cervical spine. Orthofix's M6-C disc has shown positive outcomes at the single level, and two-level trials started in August.

Artificial disc replacement has been lauded by payers and institutions, but Aetna is one prominent opponent.

In October, Aetna was ordered to face a 239-person class-action lawsuit related to its coverage lapse for lumbar disc replacement, and another lawsuit has been filed against the insurer. In both cases, Aetna denied coverage of artificial disc replacement, reasoning that it is "experimental and investigational."

Spine surgeons at the forefront of disc replacement are not buying that claim.

Jack Zigler, MD, and Richard Guyer, MD, are part of the medical team at the Texas Back Institute in Plano. The practice has performed artificial disc replacements for 22 years and...(More)

For more info please read, 'They're on really thin ice': Why 1 insurer has drawn spine surgeons' ire, by Becker's Spine Review

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