These services may or may not be covered by all CoOportunity Health plans. Please see your plan documents for your own coverage information. If there is a difference between this general information and your plan documents, your plan will be used to determine your coverage.
Administrative process
This procedure is not covered and does not require prior authorization.
The provider and facility will be liable for payment unless:
- the provider notifies the member that a specific service has been determined by CoOportunity Health to be investigational/experimental; and
- the member signs a waiver agreeing to pay for the specific non-covered service being rendered; and
- the claim has been billed with a GA modifier indicating such. If the member has signed a waiver agreeing to pay for the specific service then the member will be liable for payment.
Coverage
Artificial lumbar intervertebral disc replacement is not covered, as it is considered investigational.
Definitions
Arthroplasty is the surgical repair of a joint.
Artificial intervertebral disc replacement - also known as spinal/cervical disc arthroplasty is a procedure which replaces a degenerated spinal or cervical (neck) disc with a prosthetic disc. Lumbar artificial intervertebral disc replacement is intended as an alternative to fusion surgery and is carried out by anterior approach. Total disc replacement using an artificial intervertebral disc implant replaces the functions of the nucleus and annulus.
Examples of an artificial lumbar spine disc include the Charite artificial disc by DePuy Spine, Inc. and ProDisc®-L by Synthes Spine Inc.
Codes
If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.
This information is for most, but not all, CoOportunity Health plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.
CoOportunity Health has contracted with HealthPartners Administrators, Inc. to provide claims processing, medical management and certain other administrative services.