Medicare won't cover lumbar artificial disc replacements for 60+ patients
Device Regulation Alert: Safety, Compliance and Reimbursement News, June 11, 2007
In a proposed decision memo, CMS announced that it didn't consider lumbar artificial disc replacements (LADR) reasonable and necessary for Medicare patients over 60 years old. The proposed memo notes that no National Coverage Determination (NCD) for LADRs for patients 60 years of age or younger and that local coverage rules will apply for those patients.
CMS determined the evidence didn't support the procedure in patients older than 60 since LADRs trials focused on patients under that age.
A current NCD, (section 150.10 of the manual) addresses coverage for a specific implant (the only one approved at the time that determination was issued) but this proposed change will address coverage for the procedure using any implant for patients over 60 years of age.
CMS is soliciting comments on this proposal.
To review the proposed decision memo, click here.
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