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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules state that This A/B MAC considers United States Food and Drug Administration (FDA)-approved 
prosthetic cervical discs reasonable and necessary for the treatment of Medicare Beneficiaries with 
symptomatic cervical degenerative disease or herniated disc at a single level when all of the following criteria 
are met:  
 
The device is approved by the FDA AND 
The Beneficiary is skeletally mature AND 
The Beneficiary has EITHER: 
Intractable cervical radicular pain or myelopathy which has failed at least 6 weeks of conservative 
non-operative treatment, including physician-directed pain management (e.g., pharmacotherapy 
addressing neuropathic pain and physical therapy) OR 
Beneficiary has severe or rapidly progressive symptoms of nerve root or spinal cord compression 
requiring hospitalization or immediate surgical intervention, AND 
The Beneficiary must have clinical evidence of corresponding nerve root or spinal cord compression 
documented by computed tomography (CT), myelography, or magnetic resonance imaging (MRI), AND 
Cervical degenerative disc disease (CDDD) is from C3 to C7, AND 
The Beneficiary is free from absolute contraindications to cervical disc replacement (CDR) which include: 
Extreme obesity (BMI > 40 kg/m2) 
Significant cervical anatomical deformity 
Allergy or sensitivity to implant materials (cobalt, chromium, molybdenum, polyethylene, titanium) 
Active systemic infection or infection at the operating site 
Osteoporosis or osteopenia 
Marked cervical instability on resting lateral or flexion/extension radiographs demonstrated by 
translation greater than 3.5 mm, and/or greater than 11 angular difference to that of either level 
adjacent the treated level 
Severe spondylosis 
Clinically compromised vertebral bodies at affected level 
Two-level procedures performed simultaneously may be considered reasonable and necessary if there is 
objective clinical evidence of radiculopathy, myelopathy or spinal cord compression at 2 corresponding contiguous levels. A CDR device FDA-approved for 2 levels is required. 
 
Cervical disc replacement (CDR) is considered investigational for all other indications and conditions 
including: 
 
Disc replacement at 2 non-contiguous levels or 3 or more levels 
Combined use of an artificial cervical disc and fusion 
Prior surgery at the treated level 
Previous fusion at another level 
Any anatomical deformity (e.g., ankylosing spondylitis, trauma) 
Any autoimmune disease or rheumatoid arthritis 
Moderate to severe facet joint arthropathy at the involved level 
Metabolic bone disease (e.g., osteoporosis, Pagets disease, osteomalacia, osteogenesis imperfecta) or taking 
medications known to potentially interfere with bone/soft tissue healing (e.g., steroids) 
Malignancy 
Chronic renal failure 
 
You can find this information in the Local Coverage Determination (LCD) Cervical Disc Replacement L38033. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.