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Which Insurance Providers Cover Cervical Disc Replacement?

Published November 13, 2020
| Written By SpineNation Editorial Staff   | Medically Reviewed by Benjamin Bjerke, M.D.
Cervical disc replacement is an alternative to cervical fusion for treating pain, weakness, or numbness in the neck or arms caused by severe degenerative disc disease in the cervical spine, or neck. It is also known as cervical artificial disc surgery or cervical disc arthroplasty.

Unlike cervical fusion surgery, replacing a damaged cervical disc with an artificial disc device maintains the motion in the spine at that level. While many health insurance companies cover cervical disc replacement surgery, some still consider this to be an investigational procedure and will not cover it.

Here is a breakdown of which major health insurance companies cover this procedure, along with some of the most common requirements for qualifying for coverage. Health plan coverage sometimes changes, so check with your insurer before scheduling a cervical disc replacement.

Coverage of cervical disc replacement surgery


They base these decisions on the risks, benefits, and costs of the procedure and surgeries. Insurers may revise these lists based on new data from clinical trials or when the cost of procedures or surgeries change.

The following health insurance companies currently cover cervical disc replacement surgery if it is determined to be medically necessary. All of these insurers have restrictions on which patients qualify to have this surgery covered. The companies include:
  • Aetna
  • AmeriHealth
  • Anthem
  • Blue Cross Blue Shield of North Carolina*
  • Cigna
  • Highmark Blue Cross Blue Shield
  • Humana
  • Molina Healthcare Inc.
  • United Healthcare
* Blue Cross Blue Shield in other states may not cover cervical artificial disc replacement. Check with your insurer before scheduling surgery.

Some insurers still consider cervical disc replacement surgery for degenerative disc disease to be an experimental and investigational procedure, so they do not cover it. Check with your health insurance company before scheduling a disc replacement surgery.

Health insurance requirements for CDR

Woman-seeing-chiropractor-for-neck-pain.jpgHealth insurance companies set their own policies for which medical procedures and surgeries are covered by its health plans.
Even if your health insurance company covers cervical disc replacement surgery, your health plan may have restrictions on which patients can have this surgery covered. These restrictions vary among plans, but in general, they include the following.

Disc-related symptoms: Several conditions can cause nerve-related problems such as pain, weakness, or numbness in the neck or arms. In order for cervical disc replacement to be covered by a health plan, the symptoms need to be caused by severe degenerative disc disease in the cervical spine.

Symptoms not relieved by conservative treatment. Insurers may require that patients first try six weeks or more of conservative treatment before the company will cover cervical disc replacement surgery.

This may include physical therapy, a home program of flexibility and muscle strengthening exercises, anti-inflammatory medications, chiropractic care, acupuncture, or massage therapy.

This requirement is waived if there are signs of severe or worsening compression of the nerves or spinal cord, such as severe weakness or loss of bladder function.

Pain severe enough to impact everyday activities. The severity of pain and its effect on your life is often a key factor in whether an insurer will cover cervical disc replacement.

Stop smoking. Smoking tobacco increases the risks of surgery and can slow recovery after surgery. Insurers may recommend that patients who smoke take part in a tobacco-cessation program for several weeks prior to surgery.

Imaging showing severe disc disease. Prior to recommending cervical disc replacement surgery, a spine surgeon will order an X-ray, CT scan, or MRI to determine the cause of the symptoms. A health insurance company will only cover the cost of this procedure if the imaging shows that disc damage is the likely cause of a patient’s symptoms.

Age. To have this procedure done, patients need to be skeletally mature, which means the growth plates of their bones have closed. This usually happens by 25 years of age. Some insurers may not cover cervical disc replacement in people over age 60.

Use of an FDA-approved cervical disc device. Insurers will only cover this procedure if the device being implanted is approved by the Food and Drug Administration for use in the cervical spine.

No conditions that would prevent safe implantation of the device. A person with one of the following conditions would not be able to have cervical disc replacement surgery:
  • Infection throughout the body (such as pneumonia) or in the neck area.
  • Low bone density (osteopenia or osteoporosis)
  • Severe instability in the cervical spine
  • Damage to the cervical vertebrae due to trauma or another condition
  • Severe front-to-back curve of the upper spine (kyphosis)
  • Severe bone spurs on the vertebrae or severe disease of the facet joints of the spine
  • Sensitivity or allergy to the materials of the cervical disc device
  • Prior fusion or other spine surgery at the level of the spine to be treated

Does Medicare cover cervical disc replacement surgery?

The Centers for Medicare and Medicaid Services (CMS) does not currently have a national coverage determination in place for cervical disc replacement surgery. These decisions are made at the local level. If you are a Medicare enrollee, check with your surgeon to see if this procedure would be covered for you.

Does any insurer cover multi-level CDR?

Some people have severe disc damage at more than one level in the cervical spine. In the past, only one disc could be replaced with an artificial disc, but advances in technology now enable surgeons to replace multiple damaged discs.

The following health insurance companies cover multi-level cervical disc replacement under certain circumstances:
  • Aetna
  • AmeriHealth
  • Blue Cross Blue Shield of North Carolina*
  • Cigna
  • Highmark Blue Cross Blue Shield
  • Humana
  • Molina Healthcare Inc.
  • United Healthcare
* Blue Cross Blue Shield in other states may not cover cervical artificial disc replacement. Check with your insurer before scheduling surgery.

Patients seeking to have two-level disc replacement surgery need to meet the same requirements as for single-level disc replacements. Two-level disc replacements also have to meet the following conditions:
  • The cervical disc devices will be implanted at adjacent levels in the cervical spine — such as at C3 and C4.
  • The cervical disc device needs to be approved by the FDA for implantation at two levels
Patients seeking to have two-level disc replacement surgery need to meet the same requirements as for single-level disc replacements. Multi-level disc replacements also have to meet the following conditions:
  • The cervical disc devices will be implanted at no more than two levels.
  • The cervical disc devices will be implanted at adjacent levels in the cervical spine — such as at C3 and C4.
  • The cervical disc device needs to be approved by the FDA for implantation at two levels.
Some insurers may also cover a cervical hybrid procedure, which involves spinal fusion and cervical disc replacement at adjacent levels of the spine. These two procedures may be done during the same surgery or planned for different surgeries. Check with your insurer to find out if your health plan covers this hybrid procedure.

Summary

Cervical disc replacement is an alternative to cervical fusion surgery for treating pain, weakness or numbness in the neck or arms caused by severe degenerative disc disease in the cervical spine. Many health insurance companies cover this procedure, and some also cover multi-level disc replacements in the cervical spine.

However, insurers will not cover this procedure for every patient. Check with your insurer to see if you qualify to have cervical disc replacement covered. The staff at your spine surgeon’s office may also be able to determine if your health plan will cover this procedure.
Updated: November 18, 2020
Disclaimer

Information provided within this article is for educational purposes and is not a substitute for medical advice. Those seeking specific medical advice should consult his or her doctor or surgeon. If you need to consult with a specialist, you may be able find a health care provider in our Specialist Finder. SpineNation does not endorse treatments, procedures, products or physicians.


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Contributors and Experts

Dr. Benjamin Bjerke is fellowship-trained in neurosurgery and orthopedic spine surgery and specializes in surgical procedures of the cervical spine as well as minimally invasive lumbar procedures.
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