Anthem Blue Cross Connecticut SURG.00134 Interspinous Process Fixation Devices Form

This document addresses interspinous, non-pedicle fixation devices attached to the spinous process to achieve rigid spinal fixation and accommodate bone graft material for spinal fusion.

Note: Interspinous process fixation devices in this document differ from interspinous process spacers and dynamic stabilization systems that are motion preserving devices. Please see the following related documents for additional information concerning these devices:

• SURG.00075 Intervertebral Stabilization Devices
• SURG.00092 Implanted Devices for Spinal Stenosis

Position Statement

Investigational and Not Medically Necessary:

Interspinous process fixation devices are considered investigational and not medically necessary for all indications.