Facet arthroplasty refers to the implantation of a spinal prosthesis to restore posterior element structure and function as an adjunct to neural decompression. This procedure is proposed as an alternative to posterior spinal fusion for individuals with facet arthrosis, spinal stenosis, and spondylolisthesis. The objective of facet arthroplasty is to stabilize the spine while retaining normal intervertebral motion of the surgically removed segment following neural decompression. It is proposed that facet arthroplasty should also maintain the normal biomechanics of the adjacent vertebrae. If normal motion patterns are achieved by artificial joints in the spine, the risk of adjacent-level degeneration thought to be associated with fusion may be mitigated. No facet arthroplasty devices are approved by the U.S. Food and Drug Administration (FDA) at this time.
Total facet arthroplasty for the treatment of degenerative disc disease is considered investigational.
Any specific products referenced in this policy are just examples and are intended for illustrative purposes only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. These examples are contained in the parenthetical e.g. statement.
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
BlueCross BlueShield Association. Evidence Positioning System. (4:2018). Facet arthroplasty (7.01.120). Retrieved September 20, 2018 from https://www.evidencepositioningsystem.com (2 articles and/or guideline reviewed)
CMS.gov: Centers for Medicare & Medicaid Services. Palmetto GBA. (2018, July). Local Coverage Determination (LCD): Non-covered category III cpt codes (L34555). Retrieved September 21, 2018 from http://www.cms.gov.
Dahl, M., & Freeman, A. (2016). Kinematic and fatigue biomechanics of an interpositional facet arthroplasty device. Spine Journal, 16 (4), 531-539. Abstract retrieved December 12, 2016 from PubMed database.
Sjovold, S., Zhu, Q., Bowden, A., Larson, C., de Bakker, P., Villarraga, M., et al. (2012). Biomechanical evaluation of the total facet arthroplasty system (TFAS): loading as compared to a rigid posterior instrumentation system. European Spine Journal, 2012, 21, 1660-1673. (Level 4 evidence)
ORIGINAL EFFECTIVE DATE: 1/9/2010
MOST RECENT REVIEW DATE: 11/8/2018
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.