evekhm/cms_iom_500 huggingface dataset:
Proposed LCD - Cervical Fusion (DL39770)
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 (DL39770)
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 11/14, 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 (DL39770)
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 (DL39770)
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 (DL39770)
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 (DL39770)
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 (DL39770)
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. Accessed11/28/23.
Proposed LCD - Cervical Fusion (DL39770)
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 11/14/, 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 (DL39770)
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 Oct. 4, 2023. Accessed Oct. 30, 2023.
Proposed LCD - Facet Joint Interventions for Pain Management (DL35936)
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 Facet Joint Interventions 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/or 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 Facet Joint Interventions 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 100-02,Medicare Benefit Policy Manual, Chapter 15, Section 50 Drugs and BiologicalsCMS IOM Publication 100-03,Medicare National Coverage Determinations (NCD) Manual, Chapter 1,Part 1, Section 30.3 for AcupuncturePart 2, Section 150.7 for Prolotherapy, Joint Sclerotherapy, and Ligamentous Injections with Sclerosing AgentsPart 4, Section 220.1 for Computed Tomography (CT)CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 13,Section 10.1 Billing Part B Radiology Services and Other Diagnostic ProceduresSection 20 Payment Conditions for Radiology ServicesSection 30 Computerized Axial Tomography (CT) ProceduresCMS IOM Publication 100-08,Medicare Program Integrity Manual, Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCDSocial Security Act (Title XVIII) Standard References:
Proposed LCD - Facet Joint Interventions for Pain Management (DL35936)
CMS IOM Publication 100-08,Medicare Program Integrity Manual, Chapter 13, Section 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.Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider for any claim that lacks the necessary information to process the claim.Coverage Indications, Limitations, and/or Medical NecessityA. Facet Joint Interventions generally consist of four types of procedures: Intraarticular (IA) Facet Joint Injections, Medial Branch Blocks (MBB), Radiofrequency Ablations (RFA) and Facet cyst rupture/aspiration:Facet Joint Interventions are considered medically reasonable and necessary for the diagnosis and treatment of chronic pain in patients who meetALLthe following criteria:Moderate to severe chronic neck or low back pain, predominantly axial, that causes functional deficit measured on pain or disability scale*Pain present for minimum of 3 months with documented failure to respond to noninvasive conservative management (as tolerated)Absence of untreated radiculopathy or neurogenic claudication (except for radiculopathy caused by facet joint synovial cyst)There is no non-facet pathology per clinical assessment or radiology studies that could explain the source of the patients pain, including but not limited to fracture, tumor, infection, or significant deformity.
Proposed LCD - Facet Joint Interventions for Pain Management (DL35936)
*Pain assessment must be performed and documented at baseline, after each diagnostic procedure using thesamepain scale for each assessment. A disability scale must also be obtained at baseline to be used for functional assessment (if patient qualifies for treatment).A. Diagnostic Facet Joint Procedures (IA or MBB):The primary indication of a diagnostic facet joint procedure is to diagnose whether the patient has facet syndrome. Intraarticular (IA) facet block(s) are considered reasonable and necessary as a diagnostic test only if medial branch blocks (MMB) cannot be performed due to specific documented anatomic restrictions or there is an indication to proceed with therapeutic intraarticular injections. These restrictions must be clearly documented in the medical record and made available upon request.Diagnostic procedures should be performed with the intent that if successful, radiofrequency ablation (RFA) procedure would be considered the primary treatment goal at the diagnosed level(s).A second diagnostic facet procedure is considered medically necessary to confirm validity of the initial diagnostic facet procedure when administered at the same level. The second diagnostic procedure may only be performed a minimum of 2 weeks after the initial diagnostic procedure. Clinical circumstances that necessitate an exception to the two-week duration may be considered on an individual basis and must be clearly documented in the medical record.For the first diagnostic facet joint procedure:For the first diagnostic facet joint procedure to be considered medically reasonable and necessary, the patient must meet the criteria outlined under indications for facet joint interventions.A second confirmatory diagnostic facet joint procedure is considered medically reasonable and necessary in patients who meetALLthe following criteria:The patient meets the criteria for the first diagnostic procedure;ANDAfter the first diagnostic facet joint procedure, there must be a consistent positive response of at least 80% relief of primary (index) pain (with the duration of relief being consistent with the agent used)Frequency limitation: For each covered spinal region no more than four (4) diagnostic joint sessions will be reimbursed per rolling 12 months, in recognition that the pain generator cannot always be identified with the initial and confirmatory diagnostic procedure.B. Therapeutic Facet Joint Procedures (IA):Therapeutic facet joint injections are considered medically reasonable and necessary for patientswho meetALLthe following criteria:
Proposed LCD - Facet Joint Interventions for Pain Management (DL35936)
The patient has had two (2) medically reasonable and necessary diagnostic facet joint procedures with each one providing a consistent minimum of 80% relief of primary (index) pain (with the duration of relief being consistent with the agent used);ANDSubsequent therapeutic facet joint procedures at the same anatomic site results in at least consistent 50% pain relief for at least three (3) months from the prior therapeutic procedureorat least 50% consistent improvement in the ability to perform previously painful movements and ADLs as compared to baseline measurement using the same scale;ANDDocumentation of why the patient is not a candidate for radiofrequency ablation (such as established spinal pseudarthrosis, implanted electrical device)Frequency Limitations: For each covered spinal region no more than four (4) therapeutic facet joint (IA) sessions will be reimbursed per rolling 12 months.C. Facet Joint Denervation:The thermal radiofrequency destruction of cervical, thoracic, or lumbar paravertebral facet joint (medial branch) nervesare considered medically reasonable and necessary for patientswho meetALLthe following criteria:Initial thermal RFA:After the patient has had at least two (2) medically reasonable and necessary diagnostic MBBs, with each one providing a consistent minimum of 80% sustained relief of primary (index) pain (with the duration of relief being consistent with the agentused) ANDRepeat thermal facet joint RFA at the same anatomic site is considered medically reasonable and necessary provided the patient had a minimum of consistent 50% improvement in pain for at least six (6) monthsorat least 50% consistent improvement in the ability to perform previously painful movements and ADLs as compared to baseline measurement using the same scale;Frequency Limitation:For each covered spinal region no more than two (2) radiofrequency sessions will be reimbursed per rolling 12 months.D. Facet Cyst Aspiration/RuptureIntra-articular facet joint injection performed with synovial cyst aspiration is considered medically necessary when both of the following criteria are met:Advanced diagnostic imaging study (e.g. MRI/CT/myelogram) confirm compression or displacement of the corresponding nerve root by a facet joint synovial cyst;ANDClinical and physical symptoms related to synovial facet cyst are documented
Proposed LCD - Facet Joint Interventions for Pain Management (DL35936)
Frequency Limitation:Cyst aspiration/rupture may be repeatedonceand only if there is 50% or more consistent improvement in pain for at least three (3) months.LimitationsFacet joint interventions done without CT or fluoroscopic guidance are considered not reasonable and necessary. This includes facet joint interventions done without any guidance, performed under ultrasound guidance, or with magnetic resonance imaging (MRI).