Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut SURG.00114 Facet Joint Allograft Implants for Facet Disease Form

Effective Date

09/27/2023

Last Reviewed

08/10/2023

Original Document

  Reference



SURG.00114 Facet Joint Allograft Implants for Facet Disease

Subject:

Description/Scope

This document addresses surgically implanted allografts as a stand-alone procedure to treat facet joint pain. Facet joint pain can be caused by trauma or degenerative changes resulting in structural misalignment and instability of the vertebral column.

Note: Please see the following related document for additional information:

  • SURG.00092 Implanted Devices for Spinal Stenosis

Position Statement

Investigational and Not Medically Necessary:

Allograft facet implants are considered investigational and not medically necessary for all indications.