Anthem Blue Cross Connecticut Commercial Clinical Policy

Anthem Blue Cross Connecticut SURG.00075 Intervertebral Stabilization Devices Form

Effective Date

04/12/2023

Last Reviewed

02/16/2023

Original Document

  Reference



This document addresses the use of flexible intervertebral stabilization devices as an adjunct to spinal fusion procedures to provide immobilization and stabilization of spinal segments. Such devices are designed to allow some degree of spinal flexibility following spinal fusion surgery.

Note: This document does NOT address the use of rigid spinal fixation devices or instrumentation.

  • SURG.00092 Implanted Devices for Spinal Stenosis
  • SURG.00134 Interspinous Process Fixation Devices

Position Statement

Investigational and Not Medically Necessary:

Use of intervertebral stabilization devices is considered investigational and not medically necessary for all indications.

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