Lumbar Artificial Disc Replacement

Jurisdiction: JM Part B. States: North Carolina, South Carolina, Virginia, West Virginia. Type: Active LCD

Definitions and Scope This is a non-coverage Local Coverage Determination (LCD) for lumbar artificial disc replacement in beneficiaries 60 years of age and younger. National Coverage Determination (NCD) 150.10 makes lumbar artificial disc replacement a non-covered service for beneficiaries over 60 years of age. For beneficiaries age 60 years and younger, the NCD leaves the determination to local Medicare Administrative Contractors (MACs). This A/B MAC has determined that lumbar artificial disc replacement is not reasonable and necessary in beneficiaries 60 years of age and younger. Revision of a previously placed artificial disc is, therefore, also not covered. Artificial disc removal without prosthetic disc revision is not discussed by this LCD. Background Lower back pain is a common condition that can be caused by a number of structures in the spine, 1 of which is the intervertebral disc. For patients who have degenerative disc disease (DDD) at a single level to which their back pain is attributed and which has not responded to conservative treatment, disc replacement (also referred to as total disc arthroplasty) has been proposed as a potential treatment. The goal is to replace the degenerated disc with an artificial disc, which will not cause pain while hopefully maintaining range of motion as much as possible. A number of artificial discs have been developed for the lumbar spine, some of which have been introduced into the United States as Food and Drug Administration (FDA) approved devices.