evekhm/cms_iom_500 huggingface dataset:
Proposed LCD - Cervical Fusion (DL39758)
Zou T, Wang PC, Chen H, Feng XM, Sun HH. Minimally invasive posterior cervical foraminotomy versus anterior cervical discectomy and fusion for cervical radiculopathy: a meta-analysis.Neurosurg Rev.2022;45(6):3609-3618.Gutman G, Rosenzweig DH, Golan JD. Surgical Treatment of Cervical Radiculopathy: Meta-analysis of Randomized Controlled Trials.Spine (Phila Pa 1976).2018;43(6):E365-E372.Fei Q, Li J, Su N, et al. Comparison between anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion for the treatment of cervical spondylotic myelopathy: a meta-analysis.Ther Clin Risk Manag.2015;11:1707-1718.Han YC, Liu ZQ, Wang SJ, Li LJ, Tan J. Is anterior cervical discectomy and fusion superior to corpectomy and fusion for treatment of multilevel cervical spondylotic myelopathy? A systemic review and meta-analysis.PLoS One.2014;9(1):e87191.Li Z, Long C, Li B, Wei J. Efficacy and safety of surgical interventions for treating multilevel cervical spondylotic myelopathy via anterior approach: A network meta-analysis.Pain Physician.2019;22(4):E275.Montano N, Ricciardi L, Olivi A. Comparison of Anterior Cervical Decompression and Fusion versus Laminoplasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy: A Meta-Analysis of Clinical and Radiological Outcomes.World Neurosurg.2019;130:530-536 e532.Wang T, Guo J, Long Y, Hou Z. Comparison of Two Anterior Reconstructive Techniques in the Treatment of 3-Level and 4 Level Cervical Spondylotic Myelopathy: A Meta-analysis of Last Decade.Geriatr Orthop Surg Rehabil.2022;13:21514593221124415.
Proposed LCD - Cervical Fusion (DL39758)
Schuermans VNE, Smeets A, van de Kar LGC, et al. A Systematic Review on Neurological Outcomes for Cervical Degenerative Myelopathy After Anterior Decompression Surgery: Motion Preservation vs Fusion.Int J Spine Surg.2022;16(6):969-976.El-Ghandour NMF, Soliman MAR, Ezzat AAM, Mohsen A, Zein-Elabedin M. The safety and efficacy of anterior versus posterior decompression surgery in degenerative cervical myelopathy: a prospective randomized trial.J Neurosurg Spine.2020:1-9.Xu L, Sun H, Li Z, Liu X, Xu G. Anterior cervical discectomy and fusion versus posterior laminoplasty for multilevel cervical myelopathy: A meta-analysis.Int J Surg.2017;48:247-253.Zhao CM, Chen Q, Zhang Y, Huang AB, Ding WY, Zhang W. Anterior cervical discectomy and fusion versus hybrid surgery in multilevel cervical spondylotic myelopathy: A meta-analysis.Medicine (Baltimore).2018;97(34):e11973.Lee NJ, Kim JS, Park P, Riew KD. A comparison of various surgical treatments for degenerative cervical myelopathy: a propensity score matched analysis.Global spine journal.2022;12(6):1109-1118.Medicine JH. Cervical Myelopathy. Johns Hopkins Medicine. Cervical Myelopathy. Accessed November 14, 2023.Ranawat CS, O'Leary P, Pellicci P, Tsairis P, Marchisello P, Dorr L. Cervical spine fusion in rheumatoid arthritis.J Bone Joint Surg Am.1979;61(7):1003-1010.Gillick JL, Wainwright J, Das K. Rheumatoid arthritis and the cervical spine: a review on the role of surgery.International journal of rheumatology.2015;2015.
Proposed LCD - Cervical Fusion (DL39758)
Gillick JL, Wainwright J, Das K. Rheumatoid arthritis and the cervical spine: a review on the role of surgery.International journal of rheumatology.2015;2015.Nunez JH, Escudero B, Omiste I, et al. Outcomes of cervical arthroplasty versus anterior cervical arthrodesis: a systematic review and meta-analysis of randomized clinical trials with a minimum follow-up of 7-year.Eur J Orthop Surg Traumatol.2022.Peng Z, Hong Y, Meng Y, Liu H. A meta-analysis comparing the short- and mid- to long-term outcomes of artificial cervical disc replacement(ACDR) with anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease.Int Orthop.2022;46(7):1609-1625.Xing D, Ma XL, Ma JX, Wang J, Ma T, Chen Y. A meta-analysis of cervical arthroplasty compared to anterior cervical discectomy and fusion for single-level cervical disc disease.J Clin Neurosci.2013;20(7):970-978.Zhang Y, Lv N, He F, et al. Comparison of cervical disc arthroplasty and anterior cervical discectomy and fusion for the treatment of cervical disc degenerative diseases on the basis of more than 60 months of follow-up: a systematic review and meta-analysis.BMC Neurol.2020;20(1):143.Fehlings MG, Martin AR, Tetreault LA, et al. A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction.Global Spine J.2017;7(3 Suppl):221S-230S.Zileli M, Maheshwari S, Kale SS, Garg K, Menon SK, Parthiban J. Outcome Measures and Variables Affecting Prognosis of Cervical Spondylotic Myelopathy: WFNS Spine Committee Recommendations.Neurospine.2019;16(3):435-447.
Proposed LCD - Cervical Fusion (DL39758)
Costa F, Anania CD, Agrillo U, et al. Cervical Spondylotic Myelopathy: From the World Federation of Neurosurgical Societies (WFNS) to the Italian Neurosurgical Society (SINch) Recommendations.Neurospine.2023;20(2):415-429.Watanabe M, Chikuda H, Fujiwara Y, et al. Japanese Orthopaedic Association (JOA) Clinical practice guidelines on the Management of Cervical Spondylotic Myelopathy,2020 - Secondary publication.J Orthop Sci.2023;28(1):1-45.Youssef JA, Heiner AD, Montgomery JR, et al. Outcomes of posterior cervical fusion and decompression: a systematic review and meta-analysis.Spine J.2019;19(10):1714-1729.Mahmoud A, Shanmuganathan K, Montgomery A. Surgical Management of Hangman's Fracture: A Systematic Review.Int J Spine Surg.2023.Lee DY, Park YJ, Song MG, Kim KT, Kim DH. Comparison of anterior-only versus combined anterior and posterior fusion for unstable subaxial cervical injuries: a meta-analysis of biomechanical and clinical studies.Eur Spine J.2021;30(6):1460-1473.Yang JS, Liu P, Liu TJ, et al. When is the circumferential stabilization necessary for subaxial cervical fracture dislocations? The posterior ligament-bone injury classification and severity score: a novel treatment algorithm.Eur Spine J.2021;30(2):524-533.Madan A, Thakur M, Sud S, Jain V, Singh Thakur RP, Negi V. Subaxial Cervical Spine Injuries: Outcomes after Anterior Corpectomy and Instrumentation.Asian J Neurosurg.2019;14(3):843-847.Zheng HL, Li B, Song SK, Chen PB, Jiang LS, Jiang SD. Anterior cervical discectomy and fusion to treat cervical instability with vertigo and dizziness: A single center, retrospective, observational study.Front Surg.2022;9:1047504.
Proposed LCD - Cervical Fusion (DL39758)
Yang H, Wang H, Zhang B, Sun Y, Wang L, Lu X. Cervical spine fracture-dislocation in patients with ankylosing spondylitis and severe thoracic kyphosis: Application of halo vest before and during surgical management.Clin Neurol Neurosurg.2021;207:106744.Wang L, Wang H, Wang C, Zhang B, Yang H, Lu X. Comparative study of halo-vest reduction and skull traction reduction in the treatment of cervical fracture dislocation in patients with ankylosing spondylitis.Front Surg.2023;10:1129809.Skeppholm M, Svedmark P, Noz ME, Maguire GQ, Jr., Olivecrona H, Olerud C. Evaluation of mobility and stability in the Discover artificial disc: an in vivo motion study using high-accuracy 3D CT data.J Neurosurg Spine.2015;23(3):383-389.Rustagi T, Mashaly H, Mendel E. Posterior occiput-cervical fixation for metastasis to upper cervical spine.J Craniovertebr Junction Spine.2019;10(2):119-126.Luksanapruksa P, Millhouse PW, Carlson V, Ariyawatkul T, Heller J, Kepler CK. Comparison of Surgical Outcomes of the Posterior and Combined Approaches for Repair of Cervical Fractures in Ankylosing Spondylitis.Asian Spine J.2019;13(3):432-440.Li Z, Li F, Hou S, et al. Anterior discectomy/corpectomy and fusion with internal fixation for the treatment of unstable hangman's fractures: a retrospective study of 38 cases.J Neurosurg Spine.2015;22(4):387-393.Lee JS, Son DW, Lee SH, Ki SS, Lee SW, Song GS. Comparative Analysis of Surgical Outcomes of C1-2 Fusion Spine Surgery between Intraoperative Computed Tomography Image Based Navigation-Guided Operation and Fluoroscopy-Guided Operation.J Korean Neurosurg Soc.2020;63(2):237-247.
Proposed LCD - Cervical Fusion (DL39758)
Lang S, Neumann C, Fiedler L, Alt V, Loibl M, Kerschbaum M. Does Dynamic Anterior Plate Fixation Provide Adequate Stability for Traumatic Subaxial Cervical Spine Fractures at Mid-Term Follow-Up?J Clin Med.2021;10(6).Kong W, Yang X, Li Z, Hu B, Song Y. Analysis of the Cervical Sagittal Alignment in Patients with Unstable Hangman Fracture Under C2 approximately 3 Anterior Discectomy and Fusion.World Neurosurg.2020;137:e1-e8.Kim HS, Cloney MB, Koski TR, Smith ZA, Dahdaleh NS. Management of Isolated Atlas Fractures: A Retrospective Study of 65 Patients.World Neurosurg.2018;111:e316-e322.Bakhsheshian J, Sizdahkhani S, Ohiorhenuan I, Buchanan IA, Strickland B, Pham MH. Transpedicular lag screw placement in traumatic cervical spondylolisthesis: Case report and systematic review of the literature.J Clin Neurosci.2019;63:256-262.Jin C, Xie N, Ren Y, et al. How Does Cervical Sagittal Balance Change After Hangman Fracture Treated with Anterior or Posterior Approach Surgery?World Neurosurg.2020;138:e767-e777.Garrido BJ, Myo GK, Sasso RC. Rigid versus nonrigid occipitocervical fusion: a clinical comparison of short-term outcomes.J Spinal Disord Tech.2011;24(1):20-23.Dagtekin A, Avci E, Hamzaoglu V, et al. Management of occipitocervical junction and upper cervical trauma.J Craniovertebr Junction Spine.2018;9(3):148-155.Clark S, Nash A, Shasti M, et al. Mortality Rates After Posterior C1-2 Fusion for Displaced Type II Odontoid Fractures in Octogenarians.Spine (Phila Pa 1976).2018;43(18):E1077-E1081.
Proposed LCD - Cervical Fusion (DL39758)
Candura D, Perna A, Velluto C, et al. Conservative management of Anderson Type II odontoid fractures in octogenarians: is radiological union what we are searching for?Eur Rev Med Pharmacol Sci.2022;26(1 Suppl):33-42.Aldrian S, Erhart J, Schuster R, et al. Surgical vs nonoperative treatment of Hadley type IIA odontoid fractures.Neurosurgery.2012;70(3):676-682; discussion 682-673.Ghogawala Z, Terrin N, Dunbar MR, et al. Effect of ventral vs dorsal spinal surgery on patient-reported physical functioning in patients with cervical spondylotic myelopathy: a randomized clinical trial.Jama.2021;325(10):942-951.de Dios Perez E. Degenerative cervical myelopathy: Surgical treatment, imaging evaluation, and outcome. 2023.Sattari SA, Ghanavatian M, Feghali J, et al. Anterior cervical discectomy and fusion versus posterior decompression in patients with degenerative cervical myelopathy: a systematic review and meta-analysis.J Neurosurg Spine.2023:1-13.Selph SS SA, Jungbauer RM, Brodt E, Blazina I, Philipp TC, Mauer KM, Dettori J, Atchison C, Riopelle D, Stabler-Morris S, Fu R, Yu Y, Chou R. . Cervical Degenerative Disease Treatment: A Systematic Review. Comparative Effectiveness Review No. 266. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 75Q80120D00006.). AHRQ Publication No. 24-EHC001.Rockville, MD: Agency for Healthcare Research and Quality;.https://effectivehealthcare.ahrq.gov/products/cervical-degenerative-disease/research. Accessed November 28, 2023.
Proposed LCD - Cervical Fusion (DL39758)
Industries. WSDoL. Labor and Industries Industrial Insurance Medical Advisory Committee (IIMAC). Guideline for diagnosis and treatment of cervical radiculopathy and myelopathy. .https://www.lni.wa.gov/patient-care/treating-patients/treatment-guidelines-and-resources/_docs/2014CervicalGuideline-FINAL.pdf[lni.wa.gov]. Updated Effective December 2014, Hyperlinks and minor corrections June 2023. . Accessed11/28/23.Cohen SP. Epidemiology, diagnosis, and treatment of neck pain.Mayo Clin Proc.2015;90(2):284-299.Ohnari H, Sasai K, Akagi S, Iida H, Takanori S, Kato I. Investigation of axial symptoms after cervical laminoplasty, using questionnaire survey.Spine J.2006;6(3):221-227.(NASS) NASS. Appropriate Use Criteria: Cervical Fusion (2013) North American Spine Society (NASS). North American Spine Society: Appropriate Use Criteria for Cervical Fusion Web site.https://www.spine.org/Portals/0/assets/downloads/ResearchClinicalCare/CervicalFusionAUC.pdf. Published 2013. Accessed November 14, 2023.van Middelkoop M, Rubinstein SM, Ostelo R, et al. No additional value of fusion techniques on anterior discectomy for neck pain: a systematic review.Pain.2012;153(11):2167-2173.Riew KD, Ecker E, Dettori JR. Anterior cervical discectomy and fusion for the management of axial neck pain in the absence of radiculopathy or myelopathy.Evid Based Spine Care J.2010;1(3):45-50.Carragee EJ, Hurwitz EL, Cheng I, et al. Treatment of neck pain: injections and surgical interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.Spine (Phila Pa 1976).2008;33(4 Suppl):S153-169.
Proposed LCD - Cervical Fusion (DL39758)
Palit M, Schofferman J, Goldthwaite N, et al. Anterior discectomy and fusion for the management of neck pain.Spine (Phila Pa 1976).1999;24(21):2224-2228.Garvey TA, Transfeldt EE, Malcolm JR, Kos P. Outcome of anterior cervical discectomy and fusion as perceived by patients treated for dominant axial-mechanical cervical spine pain.Spine (Phila Pa 1976).2002;27(17):1887-1895; discussion 1895.Whitecloud TS, 3rd, Seago RA. Cervical discogenic syndrome. Results of operative intervention in patients with positive discography.Spine (Phila Pa 1976).1987;12(4):313-316.Simmons EH, Bhalla SK. Anterior cervical discectomy and fusion. A clinical and biomechanical study with eight-year follow-up.J Bone Joint Surg Br.1969;51(2):225-237.Carragee EJ, Hurwitz EL, Cheng I, et al. Treatment of neck pain: injections and surgical interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.J Manipulative Physiol Ther.2009;32(2 Suppl):S176-193.Nystrom B, Svensson E, Larsson S, Schillberg B, Mork A, Taube A. A small group Whiplash-Associated-Disorders (WAD) patients with central neck pain and movement induced stabbing pain, the painful segment determined by mechanical provocation: Fusion surgery was superior to multimodal rehabilitation in a randomized trial.Scand J Pain.2016;12:33-42.Kreiner DS, Shaffer WO, Baisden JL, et al. An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis (update).Spine J.2013;13(7):734-743.Isaac Z, Atlas SJ, K L. Management of non-radicular neck pain in adults. UpToDate. www.uptodate.com. Published 2023. Updated October 4, 2023. Accessed October 30, 2023.
Proposed LCD - Cervical Fusion (DL39762)
CMS National Coverage PolicyThis LCD supplements but does not replace, modify, or supersede existing Medicare applicable National Coverage Determinations (NCDs) or payment policy rules and regulations for cervical fusion procedures for pain management. Federal statute and subsequent Medicare regulations regarding provision and payment for medical services are lengthy. They are not repeated in this LCD. Neither Medicare payment policy rules nor this LCD replace, modify, or supersede applicable state statutes regarding medical practice or other health practice professions acts, definitions and scopes of practice. All providers who report services for Medicare payment must fully understand and follow all existing laws, regulations, and rules for Medicare payment for EPIDURAL procedures for pain management and must properly submit only valid claims for them. Please review and understand them and apply the medical necessity provisions in the policy within the context of the manual rules. Relevant CMS manual instructions and policies may be found in the following Internet-Only Manuals (IOMs) published on the CMS Web site:IOM Citations:CMS IOM Publication 100-08,Medicare Program Integrity Manual,~ Chapter 13, 13.5.4 Reasonable and Necessary Provision in an LCDSocial Security Act (Title XVIII) Standard References:Title XVIII of the Social Security Act, Section 1862(a)(1)(A) states that no Medicare payment shall be made for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury.Title XVIII of the Social Security Act, Section 1862(a)(7). This section excludes routine physical examinations.Code of Federal Regulations (CFR) References:CFR, Title 42, Ch. IV,  410.74 Physician assistants services, 410.75 Nurse practitioners services and  410.76 Clinical nurse specialists services.Coverage Indications, Limitations, and/or Medical NecessityCompliance with the provisions in this LCD may be monitored and addressed through post payment data analysis and subsequent medical review audits.History/Background and General InformationCovered IndicationsA. Cervical fusion surgery is considered medically reasonable and necessary for the decompression of symptomatic cervical nerve root impingement when all of the following requirements are met:
Proposed LCD - Cervical Fusion (DL39762)
Persistent or recurrent moderate or severe arm pain (4 or more on the visual analog scale or equivalent) present for a minimum of 12 weeks within the current episode of neck pain with documented failure to respond to multimodal conservative management (as tolerated) in the absence of exceptional circumstances (below)ANDNerve compression negatively impacts activities of daily livingANDAll other potential sources of pain/neurological deficit have been excludedANDImaging (MRI or CT) evidence of central, lateral recess or foraminal stenosis at the level corresponding with clinical myotome signs or symptoms and including at least one of the following:Cervical degenerative disc disease as indicated by the presence of one or more of the following findings: herniated nucleus pulposus, narrowing of the intervertebral disc, disc osteophytes, facet hypertrophy, or synovial cysts.Tumors (primary or metastatic)Post infection radiographic findingsSpinal instability as defined by subluxation or translation more than 3.5 mm on static lateral views or dynamic radiographs OR sagittal plane angulation of more than 11 degrees between adjacent segments.1LimitationsThe following is considered not reasonable and necessary for the decompression of symptomatic cervical nerve root impingement:Isolated chronic axial cervical painExceptions to conservative therapy requirement for decompression of symptomatic cervical nerve root impingement:MyelopathyCervical myelopathy class III or aboveORProgression of neurological deficits during the trial of conservative treatment.RadiculopathyPresenting with progressive motor weaknessORSignificant motor weakness interfering with ADLsSevere radicular pain defined as pain limiting ability to perform activities of daily living (AOLs) and 7/10 on VAS or equivalent scale2AND associated with confirmatory imaging (computed tomography, magnetic resonance imaging) and clinical-radiological correlation.Cauda equina syndrome
Proposed LCD - Cervical Fusion (DL39762)
Cauda equina syndromeB. Cervical fusion surgery is considered reasonable and necessary for the decompression of symptomatic cervical canal stenosis when the following requirements are met:1. Persistent or recurrent moderate or severe arm pain (4 or more on the visual analog scale (VAS) or equivalent) present for a minimum of 12 weeks within the episode of arm pain with documented failure to respond to multimodal conservative management (as tolerated) in the absence of exceptional circumstances (below)OR2. Nerve compression negatively impacts activities of daily livingOR3. Spastic gait, loss of manual dexterity, problems with sphincter controlAND4. All other potential sources of pain/neurological deficit have been excludedAND5. Imaging (MRI or CT) evidence of central stenosis at the level corresponding with clinical signs or symptoms and including at least one of the following:Cervical degenerative disc disease as indicated by the presence of one or more of the following findings: herniated nucleus pulposus, narrowing of the intervertebral disc, disc osteophytes, facet hypertrophy, or synovial cysts.Congenital short pediclesTumors (primary or metastatic)Post infection radiographic findingsOssification of the posterior longitudinal ligament.Spinal instability as defined by subluxation or translation more than 3.5 mm on static lateral views or dynamic radiographs OR sagittal plane angulation of more than 11 degrees between adjacent segments.Cord compression with or without increased cord signal.LimitationsThe following are considered not reasonable and necessary fordecompression of symptomatic cervical canal stenosis:Isolated chronic axial cervical pain.Asymptomatic myelopathy (regardless of severity on imaging findings).Exceptions to conservative therapy requirement for decompression of symptomatic cervical canal stenosis:MyelopathyCervical myelopathy class III or aboveORProgression of neurological deficits during the trial of conservative treatment.RadiculopathyPresenting with progressive motor weaknessORSignificant motor weakness interfering with ADLsORSevere radicular pain defined as pain limiting ability to perform activities of daily living (AOLs) and 7/10 on Visual Analog Scale (VAS) or equivalent scale2AND associated with confirmatory imaging (computed tomography, magnetic resonance imaging) and clinical-radiological correlation.Cauda equina syndrome
Proposed LCD - Cervical Fusion (DL39762)
Cauda equina syndromeC. Cervical fusion surgery is considered reasonable and necessary for the decompression or stabilization of the cervical spine for the following indications:1. Traumatic injuries including fractures, dislocations, facture-dislocations, or traumatic ligamentous disruption when3:Fractures or dislocations which are likely to result spinal instability without neurological defectsORFractures or dislocations associated with neurological defects at the affected levelORInstability is present.2. Spinal tumors involving the spine or spinal canal when:3Malignant or benign tumors which have caused instability or neurologic deficit where treatment of the tumor will likely require stabilization of the spine.4ORExpected treatment of the tumor whether by chemotherapy or radiation therapy or surgery will likely cause spinal instability or neurologic deficits.4ORInstability is present.3.Infection involving the spine in the form of discitis, osteomyelitis, or epidural abscess when3:Imaging or other studies (MRI, biopsy, bone aspirate) demonstrating infectionANDImaging evidence of vertebral body destruction OR documentation that spinal debridement will cause vertebral instability5,6ORInstability is present.4. Deformities that include the cervical spine including when3:Cervical kyphosis associated with cord compression or Atlantoaxial (C1-C2) subluxation or Basilar invagination of the odontoid process into the foramen magnum;orSubaxial (C2-T1) instability kyphosis, head drop syndrome, post-laminectomy deformity ORSymptomatic pseudarthrosis (non-union of prior fusion) with radiological (e.g., CT or MRI) demonstration of non-union of prior fusion (lack of bridging bone or abnormal motion at fused segment) after 12 months since fusion surgeryorwith radiographic evidence of hardware failure (fracture or displacement). ORSpinal instability after laminectomyORRheumatoid arthritis with associated instabilityORCervical degenerative spondylolisthesis with spinal instability (Anterolisthesis/Posterolisthesis)