BlueCross BlueShield of Tennessee Medical Policy Manual

Facet Arthroplasty


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.  No facet arthroplasty devices are approved by the U.S. Food and Drug Administration (FDA) at this time.




BlueCross BlueShield Association. Medical Policy Reference Manual. (1:2017). Facet arthroplasty (7.01.120). Retrieved October 9, 2017 from BlueWeb. (2 articles and/or guideline reviewed)

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.

National Government Services, Inc. (2016, October). LCD: Category III CPT codes (L33392). Retrieved December 12, 2016 from

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)




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