Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Jan 4, 2022

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The Lowdown

  • Medicare does not cover cervical artificial disc replacement on a national level
  • Local Medicare representatives are your best bet
  • Private insurance can be a useful option for finding coverage

Does Medicare cover cervical artificial disc replacement?

If you’re over 60, Medicare will not pay for cervical disc replacement. For patients 60 years of age and younger, a local coverage determination must be made, as Medicare does not offer a national coverage plan.

Whatever your age, you may be able to pursue other options, so seek advice from your local health insurance broker.

To find the best local insurance coverage or a Medicare Supplement plan, enter your ZIP code above, and get started now.

How much does cervical spine surgery cost?

The advantage of cervical artificial disc replacement surgery is, first and foremost, the cost. Traditional spinal fusion surgery can cost well over $100,000. In contrast, artificial disc replacement, or cervical arthroplasty, is a fraction of the expense. 

The reduction in cost comes at its own price, however. The procedure is considered investigational at this point, and thus not covered by national Medicare plans. However, your local Medicare plan may have the answer you need.

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Does Medicare cover cervical disc replacement?

According to the Centers for Medicare and Medicaid Services, local coverage determinations (LCD) may be made in each case, so seek advice from your Medicare representative. Several LCDs include cervical artificial disc replacement surgery in their coverages.

Palmetto GBA, for instance, considers prosthetic cervical discs that are approved by the Food and Drug Administration to be reasonable and necessary for the treatment of some Medicare beneficiaries. They do have restrictions, of course, so check your plan to find out if you qualify. 

Many private insurance companies share the same approach to qualification as your Medicare LCD, so it is helpful to be familiar with the requirements that need to be met. 

Is disc replacement surgery covered by insurance?

Often it is.

There are several private insurance companies that will cover cervical artificial disc replacement, or CDR. Each of them has their own restrictions, but there are some general guidelines you should know about.

In order to qualify, you will have to navigate a series of steps to receive coverage. Once you and your doctor have determined that cervical disc replacement is right for you, you can decide if local Medicare coverage, or a private insurance policy is the best way to pay for your procedure.

Whatever your decision, it is likely you will need to meet the following conditions to qualify.

How to get Disc Replacement Surgery Covered by Insurance

As there are multiple conditions that can cause severe back pain, your symptoms must be caused by severe degenerative disc disease, diagnosed by a medical doctor. You will also likely need imaging of the affected area with X-ray, CT scan, or MRI scanning.

It generally must be shown that your condition is resistant to more conservative therapy treatments. Many insurance companies will require a period of treatment with anti-inflammatory medication, physical therapy, and methods such as chiropractic care and massage. 

Your quality of everyday life must be significantly impacted by your cervical disc pain. Discuss this situation with your doctor before pursuing disc surgery.

Smoking increases the risk of complications from disc replacement surgery, so you will likely be advised to quit smoking.

Age is a factor as well, as most surgeons will require skeletal maturity. In general, this occurs after the age of 25 when the bones have stopped growing. 

You will not be able to obtain coverage for your cervical disc replacement unless the artificial disc is approved by the Food and Drug Administration.

FDA approval satisfies the need for the procedure to be “reasonable and necessary”, as per guidelines set out by the Centers for Medicare and Medicaid. Insurance companies want this level of security as well.

There are also several conditions that would prevent the safe implantation of an artificial cervical disc, such as low bone-density, or a prior spinal fusion surgery. Check with your doctor to see if any of these conditions apply to you.

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Cervical Disc Replacement and Medicare

Cervical artificial disc replacement is a complicated procedure. Finding the best way to pay for it is no picnic either. You may be able to find coverage through Medicare, or you may need to obtain a private insurance policy.

First determine if your condition meets the necessary criteria for the procedure. The checklist above should help, but if you are unsure, always ask your doctor.

Then seek out your local coverage determination to see if Medicare will cover you. If not, shop around to find the best private insurance coverage plan that meets your needs.

Finally, be certain you are getting the best quality device by using only FDA-approved artificial discs.

A great way to start your search is by letting us help you find the doctor, insurance company or advice you need. Enter you ZIP code below to find out more.