Wednesday, April 17, 2024

Does Medicare Cover Artificial Disc Replacement

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If You Are Considering Artificial Disc Replacement Here Are Seven Points You Should Understand:

What does Cervical Artificial Disc Replacement Cost? | Dr. Todd Lanman
  • Artificial disc replacement delivers better range of motion than spinal fusion surgery
  • Artificial disc replacement is not for every type of spinal pain
  • Artificial disc replacement is not right for every patient
  • Artificial discs last more than 70 years
  • Selecting an experienced surgeon is essential for getting the results you want
  • Prospective patients should ask their insurance companies how much they will have to pay out-of-pocket
  • While the overall complication rate is low, there are risks associated with any spine surgery
  • Cpt Codes Covered If Selection Criteria Are Met:

    +0098T Revision including replacement of total disc arthroplasty , anterior approach, each additional interspace, cervical 22856 Total disc arthroplasty , anterior approach, including discectomy with end plate preparation single interspace, cervical 22858 Total disc arthroplasty , anterior approach, including discectomy with end plate preparation second level, cervical 22861

    Who Qualifies For Cervical Disc Replacement

    If you live in an area where cervical disc replacement is approved under the local coverage determination, all the following statements must be true for the procedure to be covered:

    • The disc being used is approved by the FDA
    • You’re considered to be ”skeletally mature” this typically applies to anyone over the age of 25
    • You’ve either been experiencing pain that isn’t relieved through over-the-counter medications and physical therapy for at least six weeks or your symptoms are progressing rapidly and the procedure is considered urgent
    • You’ve undergone a CT scan, an MRI or myelography to diagnose your condition
    • The damaged disc is in the right location on your spine

    If you have certain medical conditions or have previously undergone back surgery, you may be ineligible for Medicare coverage even in areas where the procedure is approved.

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    The Charite Artificial Disc

    Caspi et al reported results of lumbar disk prosthesis after a follow-up period of 48 months. These investigators found that 80% of patients reported satisfactory to very good results. Poor results were reported by four patients, one of whom underwent postero-lateral fusion and another is waiting for the same operation. There were two dislocations of the prosthesis followed by immediate revision surgery. The authors concluded that contraindications for surgery appear to be the principal cause of failure rather than the prosthesis itself.

    The United States Food and Drug Administration has approved the Charite Artificial Disc for spinal arthroplasty in skeletally mature patients with degenerative disc disease at one level from L4-S1. The indications for the Charite define DDD as discogenic back pain with degeneration of the disc that is confirmed by patient history and radiographic studies. According to the FDA-approved labeling, these DDD patients should have no more than 3 mm of spondylolisthesis at the involved level. The FDA approved labeling states that patients receiving the Charite Artificial Disc should have failed at least six months of conservative treatment prior to implantation of the Charite Artificial Disc.

    The study demonstrated non-inferiority of the Charite Artificial Disc to interbody fusion for secondary endpoints, including pain ), quality of life , disc height, and device migration.

    Does Medicare Cover Back Surgery

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    Chronic back pain often requires a multi-faceted treatment plan that includes physical therapy, medication or surgical intervention. In some cases, surgery is chosen when other treatments have been tried and do not work. In others, the condition may be so severe that surgery is required. Medicare coverage for back surgery can vary due to several factors.

    Types of Back Surgery

    Whether your back pain is due to injury, degenerative disease or complications with aging, the condition of your spine and the source of the pain will determine what type of surgery may work best for you. An orthopedic specialist will assess your needs and discuss your options with you. They will also perform a physical exam and may order certain diagnostic imaging tests, such as an MRI or x-ray, to review which surgery may be medically necessary.

    The most common types of back surgery include the following:

    Risks Associated with Back Surgery

    Although many surgical procedures that relieve back pain can now be performed with minimally invasive procedures, it is still considered a major surgery. With any major surgery, there can be numerous risks. These risks include, but are not limited to, allergic reactions to anesthesia and other drugs, excessive bleeding, blood clots and infection. Certain people can be at a higher risk for a heart attack or stroke during surgery. Your surgical team should be aware of your medical history and any current medications you take in order to minimize risk.

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    How To Get Disc Replacement Surgery Covered By Insurance

    As there are multiple conditions that can cause severe back pain, your symptoms must be caused by severe degenerative disc disease, diagnosed by a medical doctor. You will also likely need imaging of the affected area with X-ray, CT scan, or MRI scanning.

    It generally must be shown that your condition is resistant to more conservative therapy treatments. Many insurance companies will require a period of treatment with anti-inflammatory medication, physical therapy, and methods such as chiropractic care and massage.

    Your quality of everyday life must be significantly impacted by your cervical disc pain. Discuss this situation with your doctor before pursuing disc surgery.

    Smoking increases the risk of complications from disc replacement surgery, so you will likely be advised to quit smoking.

    Age is a factor as well, as most surgeons will require skeletal maturity. In general, this occurs after the age of 25 when the bones have stopped growing.

    You will not be able to obtain coverage for your cervical disc replacement unless the artificial disc is approved by the Food and Drug Administration.

    FDA approval satisfies the need for the procedure to be reasonable and necessary, as per guidelines set out by the Centers for Medicare and Medicaid. Insurance companies want this level of security as well.

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    Health Insurance Requirements For Lumbar Adr

    Disc-related pain. Symptoms for at least six months.Pain not relieved by a program of conservative treatment.Imaging showing the presence of advanced disease in a single level of the lumbar spine.Pain severe enough to interfere with everyday activities. Age.Use of an FDA-approved artificial disc replacement device.

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    Lumbar Partial Disc Prosthetics

    Lumbar partial disc replacement is a minimally invasive procedure that replaces only the nucleus pulposus in an attempt to fill the therapy gap between discectomy and fusion. The procedure targets only the nucleus pulposus as the origin of pain while attempting to restore the biomechanical function of the whole segment. Careful patient selection is crucial since the prosthetic nucleus is not fixed into position. An intact annulus and properly functioning endplates must be present. Exclusion criteria include osteoporosis, endplate problems, posterior element disorder , and infection tumors. There are several lumbar partial disc replacement devices currently under investigation. These devices use hydrogel, polymer/synthetic, or mechanical technologies, however, none are commercially available in the United States. All non-fusion spinal implants are considered Class III medical devices and require Pre-Market Approval from the FDA prior to market release in the United States.

    Further clinical investigation with well-designed prospective, randomized trials is needed to determine the efficacy of nucleus replacement in the treatment of lumbar DDD, as well as its ideal indications.

    Research On The Horizon

    What does Lumbar Artificial Disc Replacement Cost? | Dr. Todd Lanman

    The future of artificial disk replacement technology will likely include advancements in the design of implants and tools for diagnosing the source of pain, as well as the development of ways to return the disk to normal function without the insertion of any biomechanical device.

    Although no longer considered a new technology, the development of artificial disk replacement is more recent than that of lumbar fusion. Follow-up studies to 10 years have shown satisfactory outcomes in a carefully chosen patient population. Despite the theoretical advantages of preserving motion, some studies have not shown a clear advantage of artificial disk replacement over lumbar fusion. Research continues on the outcomes of the procedure.

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    Evaluating Benefits & Risks Of Adr

    Dr. Lanman is a certified spine surgeon that offers Los Angeles artificial disc replacement and can answer all of your questions related to ADR. Only a qualified spine surgeon can help you decide if artificial disc replacement is right for you however, you can review the pros and cons of the procedure.

    Risks Of Artificial Disc Replacement

    The short-terms risk profile of artificial disc replacement is similar to spinal fusion surgery. However, the rate of complications is relatively low. The risk of complications can be further reduced by choosing a surgeon with the skill and experience to successfully perform artificial disc replacement surgery.

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    Cms Won’t Cover Artificial Spine Disc Replacement Device For Over

    The Centers for Medicare & Medicaid June 23 announced its decision not to cover lumbar artificial disc replacement with the ChariteTM artificial disc for Medicare beneficiaries over 60 years old.

    The agency made its national coverage decision after completing a national coverage analysis. The policy went into effect May 16, and must be implemented by insurance carriers July 17 with full implementation by Oct. 1, the agency said.

    LADR is a surgical procedure involving complete removal of a damaged or diseased lumbar intervertebral disc and implantation of an artificial disc. The procedure offers an alternative to lumbar spinal fusion and is intended to reduce pain, increase movement at the site of surgery and restore intervertebral disc height, the agency said.

    The FDA has approved the use of the ChariteTM artificial disc, made by DePuy Spine, for spine arthroplasty in skeletally mature patients with degenerative or discogenic disc disease, the CMS said. Medicare coverage under the investigational device exemption for other lumbar artificial discs in eligible clinical trials is not affected, the CMS added.

    The CMS decision can be viewed at .

    Is Disc Replacement Surgery Covered By Insurance

    What is FMLA and How Do You Use It?

    Often it is.

    There are several private insurance companies that will cover cervical artificial disc replacement, or CDR. Each of them has their own restrictions, but there are some general guidelines you should know about.

    In order to qualify, you will have to navigate a series of steps to receive coverage. Once you and your doctor have determined that cervical disc replacement is right for you, you can decide if local Medicare coverage, or a private insurance policy is the best way to pay for your procedure.

    Whatever your decision, it is likely you will need to meet the following conditions to qualify.

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    How Does Cervical Artificial Disc Replacement Work

    During cervical artificial disc replacement surgery, your doctor removes the damaged disc and inserts an artificial metal or plastic disc in its place. This disc helps reduce pressure on your vertebrae and leads to a reduction in discomfort associated with degenerative disc disease. Depending on your overall health, the procedure may be performed in a hospital on an outpatient basis, or you may need to be admitted to the hospital for one or two days during recovery.

    Things To Know About Cervical Artificial Discs

    Watch:Cervical Disc Replacement Surgery Video

    When considering cervical artificial discs, here are 6 things that are helpful for you to know:

  • Clinical trials usually show that, when compared to ACDF, cervical artificial disc surgery results in fewer overall complications, quicker return to work, and less chance of developing adjacent segment degeneration .

    See Considerations for Cervical Disc Replacement Surgery

  • A number of clinical trials for cervical artificial discs have consistently demonstrated safety and effectiveness that is at least comparable to ACDF however, for most cervical discs the FDA has not concluded that the surgery is superior to ACDF.

    See Cervical Artificial Disc Replacement Technologies

  • At present, insurance in the US will often cover this surgery, but not always, so you may want to check with your insurance carrier. If you need to pay for it yourself, the surgery will typically cost about $35,000. The alternative, ACDF, is usually covered by insurance.

    See Anterior Cervical Discectomy and Fusion Complications

  • Some surgeons are now starting to offer cervical disc replacement in an ambulatory surgery center , rather than in a hospital. In this case, the procedure costs much lessin fact, it can cost up to 80% less in an outpatient ASC than inpatient hospital setting. However, there are trade-offs with using an outpatient setting for the surgery, and this option is not available to all patients.
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    What Are The Risks Of Cervical Disk Replacement Surgery

    While any surgery carries some risk, disk replacement surgery is a relatively safe procedure. Before you have surgery, you will need to sign a consent form that explains the risks and benefits of the surgery.

    Disk replacement is a new type of spine surgery so there is little information on possible long-term risks and outcomes. Discuss with your surgeon the risks and benefits of disk replacement surgery compared with more traditional types of cervical spine surgery.

    Some potential risks of cervical spine surgery include:

    • Reactions to the anesthesia

    • Broken or loosened artificial disk

    • Need for further surgery

    There may be other risks, depending on your specific medical condition. Be sure to discuss any concerns with your surgeon before the procedure.

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    Lumbar Disc Replacement

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    Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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    How Much Does Cervical Spine Surgery Cost

    The advantage of cervical artificial disc replacement surgery is, first and foremost, the cost. Traditional spinal fusion surgery can cost well over $100,000. In contrast, artificial disc replacement, or cervical arthroplasty, is a fraction of the expense.

    The reduction in cost comes at its own price, however. The procedure is considered investigational at this point, and thus not covered by national Medicare plans. However, your local Medicare plan may have the answer you need.

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    • Currently, there is no national Medicare coverage for cervical artificial disc replacement.
    • Instead, determinations for coverage are left up to local areas.
    • Other insurance companies do offer coverage for cervical artificial disc replacement.

    Does Medicare cover cervical artificial disc replacement? Currently, there is no national coverage. The Centers for Medicare and Medicaid do not consider it to be a reasonable and necessary medical procedure for the Medicare population over 60 years of age.

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    Does Medicare Cover Cervical Artificial Disc Replacement

    • Find out when Medicare may cover the cost of cervical artificial disc replacement. Learn which parts of Medicare may help pay for the surgical procedure.

    Seven bones called cervical vertebrae form your cervical spine. In between these bones are cervical discs that act as cushions, minimizing shocks when you move your neck. Frequently, the cervical discs begin to break down with age, and in some people, this results in back and neck pain, neck stiffness, weakness of the limbs, headaches and other symptoms. If you’re suffering from the effects of a bulging or damaged disc, your doctor may diagnose you with degenerative disc disease and recommend surgery called cervical artificial disc replacement to ease discomfort. Medicare may cover this procedure if you live in certain areas and meet eligibility requirements.

    Does Medicare Cover Cervical Disc Replacement

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    According to the Centers for Medicare and Medicaid Services, local coverage determinations may be made in each case, so seek advice from your Medicare representative. Several LCDs include cervical artificial disc replacement surgery in their coverages.

    Palmetto GBA, for instance, considers prosthetic cervical discs that are approved by the Food and Drug Administration to be reasonable and necessary for the treatment of some Medicare beneficiaries. They do have restrictions, of course, so check your plan to find out if you qualify.

    Many private insurance companies share the same approach to qualification as your Medicare LCD, so it is helpful to be familiar with the requirements that need to be met.

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    Lumbar Fusion And Artificial Disk Replacement

    Although it is estimated that 70% to 80% of people will experience low back pain at some point in their lives, most will not need surgery to improve their pain. Surgery is considered when low back pain does not improve with conservative treatment.

    For patients who have exhausted nonsurgical options and are still in pain, lumbar fusion surgery remains the most common option for treating low back pain. Fusion is essentially a “welding” process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.

    While many patients are helped by lumbar fusion, the results of the surgery can vary. In addition, some patients whose fusion surgeries heal perfectly still end up with no improvement of their back pain.

    Some doctors believe that the failure to improve after fusion surgery is because fusion prevents normal motion in the spine. For this reason, artificial disk replacementâwhich aims to preserve normal motionâhas emerged as an alternative treatment option for low back pain.

    Artificial disk replacement initially gained FDA approval for use in the U.S. in 2004. Over the past several years, numerous disk replacement designs have been developed and are currently being tested.

    These x-rays, taken from the side, show patients treated with lumbar spinal fusion, and artificial disk replacement.

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