In the fall of 2013, Aetna considered changing its medical necessity policy for spine cages, but have revised their coverage decision after responses from spine organizations including the North American Spine Society, according to a NASS letter to its members.
The original coverage change would have considered spine cages only medically necessary when used with autogenous bone graft in patients meeting criteria for lumbar spinal fusion and thoracic fusion, but not cervical fusion. However, the revised coverage decision indicates it will consider cage use in cervical fusion also medically necessary for members who meet specific criteria.
Aetna continues to consider spine cages not medically necessary for cervical fusion beyond their specific requirements. Christopher Bono, MD, Christopher Kauffman, MD, and Joseph S. Cheng, MD, MS, were recognized as leaders in advocating for this coverage and promoting evidence-based medicine.
More Articles on Spine Surgery:
5 Biggest Payment Problems in Spine & Pain
Where the Spine Device Field is Headed: Q&A With Invibio's Michael Veldman
Spine Moneyball: How Analytics Will Impact Spine Care Over the Next 5 Years