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This medical policy (medical coverage guideline) is Copyright 2017, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2017 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association. The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

02-20000-36

Original Effective Date: 07/15/08

Reviewed: 01/26/17

Revised: 02/15/17

Subject: Interspinous and Interlaminar Stabilization/Distraction (Spacers) and Fixation (Fusion) Devices

THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION.

           
Position Statement Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines
           
Other References Update    
           

DESCRIPTION:

Interspinous spacers are devices implanted between vertebral spinous processes. Interlaminar spacers are implanted between adjacent lamina and have 2 sets of wings that are placed around the inferior and superior spinous processes. These implants aim to restrict painful motion while otherwise enabling normal motion. The devices (spacers) distract the laminar space and/or spinous processes and restrict extension. This procedure theoretically enlarges the neural foramen and decompresses the cauda equina in patients with spinal stenosis and neurogenic claudication.

One type of interspinous implant is inserted between the spinous processes through a small (4–8 cm) incision and acts as a spacer between the spinous processes, maintaining the flexion of that spinal interspace. The supraspinous ligament is maintained and assists in holding the implant in place. The surgery does not include any laminotomy, laminectomy, or foraminotomy at the time of insertion, thus reducing the risk of epidural scarring and cerebrospinal fluid leakage. Other interspinous spacers require removal of the interspinous ligament and are secured around the upper and lower spinous processes. Interlaminar implants are inserted between the adjacent lamina and spinous processes.

Interspinous fixation devices have evolved from spinous process wiring with bone blocks and early device designs (eg, Wilson plate, Meurig-Williams system, Daab plate). The newer devices range from paired plates with teeth to U-shaped devices with wings that are attached to the spinous process. They are intended to be an alternative to pedicle screw and rod constructs to aid in the stabilization of the spine with interbody fusion. Interspinous fixation devices are placed under direct visualization, while screw and rod systems may be placed either under direct visualization or percutaneously. Use of an interspinous fixation device in combination with a unilateral pedicle screw system has also been proposed. Interspinous fixation devices are not intended for stand-alone use. Interspinous fixation (fusion) devices contrast with interspinous distraction devices (spacers), which are used alone for decompression and are typically not fixed to the spinous process. For use in combination with fusion, it is proposed that fixation systems are less invasive and present fewer risks than pedicle or facet screws. However, while biomechanical studies indicate that fixation devices may be similar to pedicle screw-rod constructs in limiting the range of flexion-extension, they may be less effective than bilateral pedicle screw-rod fixation for limiting axial rotation and lateral bending. There is a potential for a negative impact on the interbody cage and bone graft due to focal kyphosis resulting from the device. There is also a potential for spinous process fracture.

POSITION STATEMENT:

Interspinous and interlaminar distraction devices are considered experimental or investigational as a treatment of neurogenic intermittent claudication, or any other indication.

Interlaminar stabilization devices used alone, or following decompressive surgery is considered experimental or investigational.

Interspinous fixation (fusion) devices are considered experimental or investigational for any indication, including but not limited to use in combination with interbody fusion, or used alone for decompression to treat spinal stenosis.

There is insufficient clinical evidence in the peer reviewed literature demonstrating the safety and efficacy of these procedures, or demonstrating the effects of these procedures on long-term health outcomes.

BILLING/CODING INFORMATION:

The following codes may be used to describe distraction devices:

CPT Coding

22867

Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level (Investigational)

22868

Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; second level (List separately in addition to code for primary procedure) (Investigational)

22869

Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level (Investigational)

22870

Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level (List separately in addition to code for primary procedure) (Investigational)

There are no specific CPT codes for insertion of interspinous fixation (fusion) devices.

REIMBURSEMENT INFORMATION:

Refer to sections entitled POSITION STATEMENT and PROGRAM EXCEPTIONS.

PROGRAM EXCEPTIONS:

Federal Employee Program (FEP): Follow FEP guidelines.

State Account Organization (SAO): Follow SAO guidelines.

Medicare Advantage products:

The following Local Coverage Determination (LCD) was reviewed on the last guideline reviewed date: Interspinous Process Decompression (L34006) located at fcso.com.

DEFINITIONS:

Neural foramen: the passage formed by the inferior and superior notches on the pedicles of adjacent vertebrae; it transmits a spinal nerve and vessels.

Neurogenic claudication: a type of claudication that is accompanied by pain and paresthesias in the back, buttocks, and lower limbs and is relieved by stooping or sitting. The usual cause is a mechanical disturbance due to posture, and a rare cause is ischemia of the cauda equina.

Spinal stenosis: narrowing of the vertebral canal, nerve root canals, or intervertebral foramina of the lumbar spine caused by encroachment of bone upon the space; symptoms are caused by compression of the cauda equina and include pain, paresthesias, and neurogenic claudication. The condition may be either congenital or due to spinal degeneration.

RELATED GUIDELINES:

Total Facet Arthroplasty, 02-20000-37

OTHER:

Index terms:

Note: The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available.

REFERENCES:

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  2. AHRQ National Guideline Clearinghouse. Guideline Summary 10647: Low back pain medical treatment guidelines. Colorado Division of Workers' Compensation. Denver (CO): Colorado Division of Workers' Compensation; 2014 Feb 3.
  3. American Academy of Orthopaedic Surgeons. Lumbar Spinal Stenosis. May 2009.
  4. Bae HW, Lauryssen C, Maislin G, Leary S, Musacchio MJ Jr. Therapeutic sustainability and durability of coflex interlaminar stabilization after decompression for lumbar spinal stenosis: a four year assessment. Int J Spine Surg. 2015 May 11;9:15.
  5. Blue Cross Blue Shield Association. Medical Policy Reference Manual. 7.01.107. Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers). April 2016.
  6. Blue Cross Blue Shield Association. Medical Policy Reference Manual. 7.01.138. Interspinous Fixation (Fusion) Devices. September 2014.
  7. Brussee P, Hauth J, Donk RD, et al. Self-rated evaluation of outcome of the implantation of interspinous process distraction (X-Stop) for neurogenic claudication. Eur Spine J 2007 Oct 31.
  8. California Technology Assessment Forum (CTAF). An Interspinous Distractor (X STOP) For The Treatment of Spinal Stenosis of The Lumbar Spine. (06/21/06).
  9. Celik H, Derincek A, Kosal I. Surgical Treatment of the Spinal Stenosis with an Interspinous Distraction Device: Do We Really Restore the Foraminal Height? Turkish Neurosurgery 2012, Vol: 22, No: 1, 50-54.
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  12. Clinical Trials.gov. Effects of XSTOP® Versus Laminectomy Study (EXELS). Identifier: NCT00558129 Verified by Kyphon, November 2007.
  13. Clinical Trials.gov. Long-Term Outcomes for Lumbar Spinal Stenosis Patients Treated with X STOP®. Identifier: NCT00534092. Verified by Kyphon, July 2011. Last updated 02/16/12 with study results. (Accessed 09/30/13).
  14. Clinical Trials.gov. Treatment of Lumbar Spinal Stenosis; Comparison of Two Different Surgical Methods; X-Stop (LSSS). Identifier: NCT00546949. Verified by Norwegian University of Science and Technology, October 2007.
  15. Clinical Trials.gov. Post-Approval Clinical Trial Comparing the Long Term Safety and Effectiveness Coflex vs. Fusion to Treat Lumbar Spinal Stenosis. Identifier: NCT00534235. Verified by Paradigm Spine, November 2012.
  16. Clinical Trials.gov. A Randomized Controlled Trial Comparing Surgical Decompression With an Interlaminar Implant in Patients With Intermittent Neurogenic Claudication Caused by Lumbar Stenosis (FELIX). Identifier: NCT01727752. Verified by Paradigm Spine, November 2012.
  17. ClinicalTrials.gov. Efficacy of the Aspen Spinous Process System in Anterior Lumbar Interbody Fusion (ALIF). Identifier: NCT01016314. Verified by Biomet, Inc.: December 2013.
  18. ClinicalTrials.gov. An Evaluation of Interlaminar Lumbar Instrumented (ILIF™). Identifier: NCT01019057. Verified by NuVasive: July 2014.
  19. ClinicalTrials.gov. Clinical Trial Comparing Decompression With and Without Coflex™ Interlaminar Technology Treating Lumbar Spinal Stenosis. Identifier: NCT01316211. Verified by Paradigm Spine (October 2016).
  20. ClinicalTrials.gov. The Coflex®COMMUNITY Study: An Observational Study of Coflex® Interlaminar Technology. Identifier: NCT02457468. Verified by Predicted, Reported and Observed Outcomes Foundation (December 2016),
  21. ClinicalTrials.gov. Post-Approval 'Real Conditions of Use' Study (PAS003). Identifier: NCT02555280. Verified by Paradigm Spine (October 2016).
  22. Coe JD et al. NFlex Dynamic Stabilization System: Two-Year Clinical Outcomes of Multi-Center Study. J Korean Neurosurg Soc 51 : 343-349, 2012.
  23. Davis R, Auerbach JD, Bae H, Errico TJ. Can low-grade spondylolisthesis be effectively treated by either coflex intermalimar stabilization or laminectomy and posterior spinal fusion? Two-year clinical and radiographic results from the randomized, prospective, multicenter US investigational device exemption trial. J Neurosurg: Spine | May 31, 2013.
  24. Decompression and Coflex interlaminar stabilization compared with decompression and instrumented spinal fusion for spinal stenosis and low-grade degenerative spondylolisthesis: two-year results from the prospective, randomized, multicenter, Food and Drug Administration Investigational Device Exemption trial. Spine (Phila Pa 1976). Aug 15 2013;38(18):1529-1539.
  25. ECRI. Target Database Report. Interspinous process decompression to treat spinal stenosis. Plymouth Meeting, PA: ECRI. 09/07.
  26. ECRI Institute Product Brief. Coflex and Coflex-F Implants (Paradigm Spine, LLC) for Lumbar Spinal Disorders. October 2013.
  27. Epstein NE. A review of interspinous fusion devices: High complication, reoperation rates, and costs with poor outcomes. Surg Neurol Int 2012, 3:7.
  28. Fabrizi AP, Maina R, Schiabello L. Interspinous spacers in the treatment of degenerative lumbar spinal disease: our experience with DIAM and Aperius devices. Eur Spine J. 2011 May;20 Suppl 1:S20-6.
  29. First Coast Service Options, Inc. (FCSO). Florida Medicare Part B Local Coverage Determination. Interspinous Process Decompression (L34006) (10/01/15).
  30. Florida Medicare Part B Local Coverage Determination. Interspinous Process Decompression (L25281) (08/06/07) (Retired 02/01/09).
  31. Florida Medicare Part B Local Coverage Determination. Interspinous Process Decompression (L29204) (02/02/09) (Revised 10/01/10). (Retired 09/30/15)
  32. Grob D, Benini A, Junge A, Mannion AF. Clinical Experience With the Dynesys Semirigid Fixation System for the Lumbar Spine: Surgical and Patient-Oriented Outcome in 50 Cases After an Average of 2 Years. SPINE Volume 30, Number 3, pp 324–331 ©2005.
  33. Hayes, Inc. Health Technology Brief. X Stop® Interspinous Process Decompression System (Kyphon Inc.) for Lumbar Spinal Stenosis. Lansdale, PA: Hayes, Inc.; 11/13/07.
  34. Hayes, Inc. Hayes alert. FDA Clears New Implant to Treat Lumbar Stenosis. Lansdale, PA: Hayes, Inc.; 01/17/06.
  35. Heyrani N, Picinic Norheim E, Elaine Ku Y, Nick Shamie A. Interspinous process implantation for the treatment of neurogenic intermittent claudication. Anesth Pain Med. 2012 Summer;2(1):36-41.
  36. Hobart J, Gilkes C, Adams W, Germon T. Interspinous spacers for lumbar foraminal stenosis: formal trials are justified. Eur Spine J. 2013 Mar;22 Suppl 1:S47-53.
  37. Holinka J, Krepler P, Matzner M, Grohs JG. Stabilising effect of dynamic interspinous spacers in degenerative low-grade lumbar instability. International Orthopaedics (SICOT) (2011) 35:395–400.
  38. InterQual® 2011. CP:Procedures Adult Interspinous Process Decompression.
  39. InterQual® 2013. Adult CP: Procedures: Interspinous Process Decompression.
  40. InterQual® 2014. CP: Procedures. Interspinous Process Decompression.
  41. Kim HJ, Bak KH, Chun HJ, Oh SJ, Kang TH, Yang MS. Posterior Interspinous Fusion Device for One-Level Fusion in Degenerative Lumbar Spine Disease: Comparison with Pedicle Screw Fixation - Preliminary Report of at Least One Year Follow Up. J Korean Neurosurg Soc 52: 359-364, 2012.
  42. Kondrashov DG, Hannibal M, Hsu KY et al. Interspinous process decompression with the X-STOP device for lumbar spinal stenosis: a 4-year follow-up study. J Spinal Disord Tech 2006; 19(5): 323-7.
  43. Kumar N, Shah SM, Ng YH, Pannierselvam VK, Dasde S, Shen L. Role of coflex as an adjunct to decompression for symptomatic lumbar spinal stenosis. Asian Spine J. 2014 Apr;8(2):161-9.
  44. Landi A. Elastic resistance of the spine: Why does motion preservation surgery almost fail? World J Clin Cases. 2013 Jul 16;1(4):134-9.
  45. Landi A. Interspinous posterior devices: What is the real surgical indication? World J Clin Cases. 2014 Sep 16;2(9):402-8.
  46. Machado GC, Ferreira PH, Harris IA, Pinheiro MB, Koes BW, van Tulder M, Rzewuska M, Maher CG, Ferreira ML. Effectiveness of surgery for lumbar spinal stenosis: a systematic review and meta-analysis. PLoS One. 2015 Mar 30;10(3):e0122800.
  47. Maida G, Marcati E, Sarubbo S. Heterotopic Ossification in Vertebral Interlaminar/Interspinous Instrumentation: Report of a Case. Case Reports in Surgery Volume 2012, Article ID 970642.
  48. Manufacturer Instructions for Use: coflex® Interlaminar Technology, 2012. (Paradigm Spine; New York, NY)
  49. Miller LE, Block JE. Interspinous Spacer Implant in Patients with Lumbar Spinal Stenosis: Preliminary Results of a Multicenter, Randomized, Controlled Trial. Pain Research and Treatment Volume 2012, Article ID 823509.
  50. Modhia U, et al. Readmission rates after decompression surgery in patients with lumbar spinal stenosis among Medicare beneficiaries. Spine (Phila Pa 1976). 2013 Apr 1;38(7):591-6.
  51. Moojen WA et al. Effectiveness of interspinous implant surgery in patients with intermittent neurogenic claudication: a systematic review and meta-analysis. Eur Spine J (2011) 20:1596–1606.
  52. Moojen WA, et al. Interspinous process device versus standard conventional surgical decompression for lumbar spinal stenosis: randomized controlled trial. BMJ. 2013 Nov 14;347:f6415.
  53. Musacchio MJ, et al. Evaluation of Decompression and Interlaminar Stabilization Compared with Decompression and Fusion for the Treatment of Lumbar Spinal Stenosis: 5-year Follow-up of a Prospective, Randomized, Controlled Trial. Int J Spine Surg. 2016; 10: 6.
  54. National Institute for Clinical Excellence (NICE): Non-rigid stabilisation procedures for the treatment of low back pain. Issue date: June 2006. (Accessed on 01/22/10).
  55. National Institute for Clinical Excellence (NICE). Interventional procedure guidance 365: Interspinous distraction procedures for lumbar spinal stenosis causing neurogenic claudication. Issue Date: November 2010.
  56. National Institute for Clinical Excellence (NICE). Interventional procedure guidance 366: Non-rigid stabilisation techniques for the treatment of low back pain. Issue date: November 2010.
  57. National Institute for Clinical Excellence (NICE): Treating neurogenic claudication caused by lumbar spinal stenosis using a spacer device between the vertebrae (patient guide). November 2010.
  58. North American Spine Society. Evidence-based clinical guidelines for multidisciplinary spine care: Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis (2008).
  59. North American Spine Society. Evidence-based clinical guidelines for multidisciplinary spine care: Diagnosis and treatment of degenerative lumbar spinal stenosis. January 2007; Revised 2011.
  60. North American Spine Society (NASS). NASS coverage policy recommendations: Interspinous fixation with fusion. Accessed at https://www.spine.org.
  61. North American Spine Society. NASS coverage policy recommendations: Interspinous device without fusion. 2014. Accessed at https://www.spine.org.
  62. Paradigm Spine Press Release: U.S. FDA PMA Approval Of Its Landmark Coflex® Interlaminar Technology: The 1st Comparative Effectiveness Study For the Treatment Of Spinal Stenosis. October 17, 2012; New York, NY.
  63. Parker SL, Anderson LH, Nelson T, Patel VV. Cost-effectiveness of three treatment strategies for lumbar spinal stenosis: Conservative care, laminectomy, and the Superion interspinous spacer. Int J Spine Surg. 2015 Jul 9;9:28.
  64. Patel VV, Whang PG, Haley TR, Bradley WD, Nunley PD, Miller LE, Block JE, Geisler FH. Two-year clinical outcomes of a multicenter randomized controlled trial comparing two interspinous spacers for treatment of moderate lumbar spinal stenosis. BMC Musculoskelet Disord. 2014 Jul 5;15:221.
  65. Putzier M. The surgical treatment of the lumbar disc prolapse: nucleotomy with additional transpedicular dynamic stabilization versus nucleotomy alone. Spine (Phila Pa 1976). 2005 Mar 1;30 (5): E109-14.
  66. Putzier M et al. Dynamic stabilization adjacent to single-level fusion: Part II. No clinical benefit for asymptomatic, initially degenerated adjacent segments after 6 years follow-up. Eur Spine J (2010) 19:2181–2189.
  67. Richter A, Schutz C, Hauck M, Halm H. Does an interspinous device (CoflexTM) improve the outcome of decompressive surgery in lumbar spinal stenosis? One-year follow up of a prospective case control study of 60 patients. Eur Spine J (2010) 19:283–289.
  68. Schnake KJ. Dynamic Stabilization in Addition to Decompression for Lumbar Spinal Stenosis with Degenerative Spondylolisthesis. Spine (Phila Pa 1976). 2006 Feb 15;31(4): 442-9.
  69. Sclafani JA, Liang K, Ohnmeiss DD, Gordon C. Clinical outcomes of a polyaxial interspinous fusion system. Int J Spine Surg. 2014 Dec 1;8.
  70. Sears WR, et al. Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis. Spine J. 2011 Jan;11(1):11-20.
  71. Shabat S, Miller LE, Block JE, Gepstein R. Minimally invasive treatment of lumbar spinal stenosis with a novel interspinous spacer. Clinical Interventions in Aging 2011:6 227–233.
  72. Strube P et al. Dynamic stabilization adjacent to single-level fusion: Part I. Biomechanical effects on lumbar spinal motion. Eur Spine J (2010) 19:2171–2180.
  73. Stoll TM. The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system. Eur Spine J. 2002 Oct;11 Suppl 2: S170-8. Epub 2002 Sep 10.
  74. The International Society for the Advancement of Spine Surgery (ISASS). Recommendations/Coverage Criteria for Decompression with Interlaminar Stabilization – Coverage Indications, Limitations, and/or Medical Necessity. Volume 10, Article 41. November 2016.
  75. U.S. Food and Drug Administration (FDA), Rockville (MD): U.S. Department of Health and Human Services. Available from: http://www.fda.gov.
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  77. U.S. Food and Drug Administration. Summary of safety and effectiveness data: coflex Interlaminar Technology. 2012. Accessed at: http://www.accessdata.fda.gov/cdrh_docs/pdf11/P110008b.pdf. on 09/30/13.
  78. Verhoof OJ, Bron JL, Wapstra FH et al. High failure rate of the interspinous distraction device (X-Stop) for the treatment lumbar spinal stenosis caused by degenerative spondylolisthesis. Eur Spine J 2008; 17(2): 188-92. (Accessed 11/13/11).
  79. Welch WC. Clinical outcomes of the Dynesys dynamic neutralization system: 1-year preliminary results. Neurosurg Focus. 2007 Dec 15;22 (1): E8.
  80. Wu AM, Zhou Y, Li QL, Wu XL, Jin YL, Luo P, Chi YL, Wang XY. Interspinous spacer versus traditional decompressive surgery for lumbar spinal stenosis: a systematic review and meta-analysis. PLoS One. 2014 May 8;9(5):e97142.
  81. Zang L, DU P, Hai Y, Su QJ, Lu SB, Liu T. Device related complications of the Coflex interspinous process implant for the lumbar spine. Chin Med J (Engl). 2013 Jul;126(13):2517-22.
  82. Zhou D, Nong LM, DU R, Gao GM, Jiang YQ, Xu NW. Effects of interspinous spacers on lumbar degenerative disease. Exp Ther Med. 2013 Mar;5(3):952-956.
  83. Zucherman JF, Hsu KY, Hartjen CA et al. A multicenter, prospective randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results. Spine 2005;0(12): 1351-8. (Accessed 11/13/11).

COMMITTEE APPROVAL:

This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 01/26/17.

GUIDELINE UPDATE INFORMATION:

07/15/08

New Medical Coverage Guideline.

04/15/09

HCPCS code C1821 deleted from policy.

06/15/09

Scheduled review; no change in position statement. Update references.

04/15/10

Annual review; added investigational statement for dynamic spinal stabilization to position statement; description of dynamic spinal stabilization devices added to description section; references updated; and guideline title revised.

12/15/11

Scheduled review; no change in position statement. Updated description section and references.

11/15/12

Scheduled review; position statement maintained. Revised description and Medicare Advantage program exception (added utilization guidelines). Updated references.

07/15/13

Revision; updated description section (coflex® Interlaminar Technology implant language). Revised Program Exceptions section and index terms. Updated references.

11/15/13

Scheduled review. Revised MCG title and description section. Maintained position statement. Revised index terms. Updated references.

01/01/15

Scheduled review. Position statement maintained. Revised description section and index terms. Updated references.

10/15/15

Scheduled review. Revised description section and index terms. Updated references.

01/01/17

Annual CPT/HCPCS update. Added 22867, 22868, 22869, 22870. Deleted 0171T, 0172T.

02/15/17

Scheduled review. Maintained Position Statement section. Updated references.

Date Printed: June 28, 2017: 11:57 PM