GoHealthcare Spine Specialty Guide
Spine Procedure Library
A structured navigation page for cervical, thoracic, lumbar, fusion, decompression, motion-preservation, vertebral augmentation, interventional, and complex spine procedure resources.
Developed by Pinky Maniri, MSc, BSc, CRCR, CSAPM, CSPPM, CSBI, CSPR, CSAF, Certified in Healthcare A.I. Governance | Founder and Chief Executive Officer, GoHealthcare Practice Solutions
CervicalThoracicLumbarFusionDecompressionInterventional Spine
Important Notice. This page is an educational and operational reference. It is not a surgical technique manual, a substitute for physician clinical judgment, coding advice for a specific claim, or legal advice. Coverage, authorization, coding, and payment requirements vary by payer, product, state, contract, and date of service. Verify current requirements before reliance.
SpecialtySpine Care
ResourceSpine Procedure Library
AudiencePhysicians, APPs, administrators, PA/UM, RCM, ASCs, hospitals, and executives
Verification StandardConfirm current payer, CMS, coding, contractual, and state requirements
How to Use the Spine Procedure Library
Every procedure should be published as a standalone evergreen page under the GoHealthcare Procedure Library Master Framework. Each page should address medical necessity, documentation, Medicare and MAC policy, commercial payer and delegated UM requirements, prior authorization, coding, reimbursement, denial prevention, appeals, clinical and operational pearls, FAQs, related procedures, and authoritative references.
GoHealthcare Perspective
The procedure library is an operational decision-support resource. It should help the reader understand what must be clinically documented, administratively verified, authorized, coded, billed, and governed-not teach surgical technique.
Cervical Spine Procedures
01
Anterior Cervical Discectomy and Fusion
Clinical documentation, levels, decompression, fusion, instrumentation, device, site of service, authorization, and coding.
02
Posterior Cervical Decompression and Fusion
Myelopathy, stenosis, instability, multilevel planning, instrumentation, inpatient or outpatient setting, and revision considerations.
03
Cervical Disc Arthroplasty
Device eligibility, levels, contraindications, prior surgery, facet status, payer technology policy, and reimbursement.
04
Cervical Laminectomy and Laminoplasty
Neurological findings, imaging, levels, alignment, instability, decompression, and fusion decision.
05
Cervical Foraminotomy
Radiculopathy, laterality, imaging correlation, treatment history, level, approach, and coding.
06
Cervical Corpectomy
Vertebral-body pathology, decompression, reconstruction, fusion, instrumentation, implant, and facility planning.
Thoracic Spine Procedures
01
Thoracic Laminectomy and Decompression
Thoracic pathology, neurological findings, imaging, levels, approach, and site-of-care considerations.
02
Thoracic Discectomy
Disc pathology, cord or root compression, approach, imaging, level, and inpatient or facility requirements.
03
Thoracic Fusion and Instrumentation
Instability, deformity, fracture, tumor, infection, levels, instrumentation, graft, and implant economics.
04
Thoracic Deformity Correction
Alignment, curve, osteotomy, staged surgery, risk, inpatient resources, and postoperative transition.
05
Thoracic Fracture Stabilization
Fracture pattern, stability, neurological status, trauma pathway, fixation, and admission status.
06
Thoracic Vertebral Augmentation
Compression fracture acuity, imaging, pain and function, contraindications, authorization, coding, and reimbursement.
Lumbar Decompression Procedures
01
Lumbar Laminectomy
Stenosis, claudication, objective findings, imaging, levels, conservative care, authorization, and coding.
02
Lumbar Laminotomy
Focal decompression, level, laterality, imaging correlation, operative documentation, and billing.
03
Lumbar Foraminotomy
Foraminal stenosis, radiculopathy, side, level, imaging, treatment history, and coding.
04
Lumbar Microdiscectomy
Disc herniation, radiculopathy, neurological findings, imaging, side, level, conservative care or exception.
05
Endoscopic Lumbar Discectomy
Technology status, approach, policy coverage, documentation, code selection, site, and payer variation.
06
Minimally Invasive Lumbar Decompression
Lumbar stenosis pathway, imaging, ligamentous pathology, function, policy, authorization, and coding.
Lumbar Fusion and Reconstruction
01
Anterior Lumbar Interbody Fusion
Anterior approach, interspace, access surgeon, fusion, instrumentation, graft, implant, facility, and authorization.
02
Posterior Lumbar Interbody Fusion
Posterior interbody approach, decompression, fusion, instrumentation, levels, add-on coding, and operative reconciliation.
03
Transforaminal Lumbar Interbody Fusion
Transforaminal approach, unilateral or bilateral work, decompression, fusion, instrumentation, and payer criteria.
04
Direct or Extreme Lateral Interbody Fusion
Lateral approach, levels, neuromonitoring, device, instrumentation, site, coverage, and coding.
05
Oblique Lateral Interbody Fusion
Oblique approach, interspace, implant, staged posterior work, payer policy, and facility readiness.
06
Posterolateral Lumbar Fusion
Instability, fusion rationale, levels, instrumentation, graft, decompression relationship, and reimbursement.
07
Lumbar Disc Arthroplasty
Device eligibility, level restrictions, contraindications, prior surgery, payer technology policy, and implant.
08
Lumbar Revision and Pseudarthrosis Surgery
Prior records, hardware, fusion status, failure mechanism, infection, bone health, revision plan, and payment risk.
09
Adult Spinal Deformity Surgery
Alignment, multilevel fusion, osteotomy, staging, implants, inpatient resources, outcomes, and episode economics.
Sacroiliac, Vertebral, and Motion-Preservation Procedures
01
Sacroiliac Joint Fusion
Diagnostic pathway, competing pain generators, imaging, treatment history, device, site, and payer policy.
02
Kyphoplasty
Fracture acuity, imaging, pain, function, malignancy or osteoporosis, authorization, coding, and facility.
03
Vertebroplasty
Coverage policy, fracture or lesion documentation, imaging, contraindications, coding, and reimbursement.
04
Interspinous or Interlaminar Stabilization
Device-specific criteria, stenosis, instability, contraindications, policy variation, and site of service.
05
Basivertebral Nerve Ablation
Vertebrogenic pain, Modic changes, treatment history, policy, prior authorization, coding, and denial prevention.
06
Bone Growth Stimulation
Fusion risk, nonunion or adjunct criteria, DME supplier documentation, modifiers, delivery, and payer coverage.
Interventional Spine and Neuromodulation
| Procedure Group | GoHealthcare Resources |
|---|---|
| Epidural steroid injections | Cervical interlaminar ESI, cervical transforaminal ESI, lumbar interlaminar ESI, lumbar transforaminal ESI, caudal ESI |
| Facet diagnostic procedures | Cervical, thoracic, and lumbar medial branch blocks; facet joint injections; facet cyst aspiration or rupture |
| Radiofrequency procedures | Cervical, thoracic, and lumbar medial branch radiofrequency ablation; sacral lateral branch procedures |
| Neuromodulation | Spinal cord stimulation, dorsal root ganglion stimulation, peripheral nerve stimulation, trial, implant, revision, replacement, removal |
| Vertebral and minimally invasive procedures | Kyphoplasty, vertebroplasty, basivertebral nerve ablation, minimally invasive lumbar decompression, interspinous procedures |
Browse the existing GoHealthcare Procedure Library for published pages. Individual surgical procedure links should be activated after the corresponding evergreen page is live and its final permalink is confirmed.
Published GoHealthcare Procedure Resources
| Resource | Link |
|---|---|
| GoHealthcare Procedure Library | https://www.gohealthcarellc.com/procedure-library.html |
| Cervical Interlaminar Epidural Steroid Injection | https://www.gohealthcarellc.com/cervical-interlaminar-epidural-steroid-injection.html |
| Cervical Medial Branch Block | https://www.gohealthcarellc.com/cervical-medial-branch-block.html |
| Lumbar Medial Branch Block | https://www.gohealthcarellc.com/lumbar-medial-branch-block.html |
| Prior Authorization Overview | https://www.gohealthcarellc.com/overview.html |
| Billing and Coding: Lumbar Spinal Fusion Approaches | https://www.gohealthcarellc.com/blog/billing-and-coding-lumbar-spinal-fusion-plif-tlif-alif-dlif-olif-and-instrumentation |
| Revenue Integrity for Pain, Spine and MSK Specialty Care | https://www.gohealthcarellc.com/revenue-integrity-msk-specialty-care.html |
Procedure Page Publication Standard
- Overview and operational significance.
- Care pathway and patient selection.
- Medical necessity and documentation requirements.
- CMS national guidance, NCDs, LCDs, Billing and Coding Articles, and MAC-specific requirements.
- Commercial payer, BCBS, Carelon, eviCore, Cohere, Evolent, and plan-specific variation.
- Prior authorization workflow, determination validation, denial prevention, appeals, and peer-to-peer preparation.
- CPT and HCPCS coding, ICD-10-CM crosswalk, modifiers, NCCI, global surgery, and facility alignment.
- Reimbursement, implants, site of service, and revenue integrity.
- GoHealthcare Perspective, GoHealthcare Insights, Documentation Pearls, Payer Perspective, Clinical Pearls, FAQs, related procedures, and authoritative references.
Operational Rule
Never represent an unpublished procedure page as live. Confirm the final URL before converting a title into a clickable internal link.
Frequently Asked Questions
Why is each procedure a separate page?
Standalone pages improve search authority, policy maintenance, internal linking, user navigation, and the ability to address procedure-specific documentation, coding, authorization, and reimbursement.
Are all procedures on this page currently live?
No. The page is both a navigation resource and publication roadmap. Only confirmed published resources should be linked as live.
Should spine surgery and interventional pain procedures be in the same library?
They can share the central MSK procedure library while remaining organized by specialty, region, procedure family, and clinical pathway.
What information belongs on every procedure page?
Medical necessity, documentation, Medicare and commercial payer policy, prior authorization, coding, reimbursement, denials, appeals, pearls, FAQs, related procedures, and references.
How should procedure URLs be named?
Use concise, descriptive, lowercase, hyphenated permalinks based on the procedure name and avoid unnecessary dates or numbers.
How should payer variation be presented?
Identify the payer, product, delegated reviewer, effective date, and plan-specific variation. Do not generalize one policy to all plans.
Related Spine Specialty Pages
Authoritative References and Related Resources
Policies, code sets, payment rules, and utilization-management requirements change. Verify the live source for the patient's payer, product, MAC jurisdiction, delegated reviewer, procedure, facility, device, and date of service.
- Centers for Medicare & Medicaid Services. Medicare Coverage Database.
https://www.cms.gov/medicare-coverage-database/search.aspx - Centers for Medicare & Medicaid Services. Prior Authorization for Certain Hospital Outpatient Department Services.
https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/prior-authorization-pre-claim-review-initiatives/prior-authorization-certain-hospital-outpatient-department-opd-services - Centers for Medicare & Medicaid Services. Final List of Hospital Outpatient Department Services Requiring Prior Authorization.
https://www.cms.gov/files/document/opd-services-require-prior-authorization.pdf - Centers for Medicare & Medicaid Services. Calendar Year 2026 Medicare Physician Fee Schedule Final Rule.
https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2026-medicare-physician-fee-schedule-final-rule-cms-1832-f - Centers for Medicare & Medicaid Services. Calendar Year 2026 OPPS and ASC Final Rule.
https://www.cms.gov/newsroom/fact-sheets/calendar-year-2026-hospital-outpatient-prospective-payment-system-opps-ambulatory-surgical-center - Centers for Medicare & Medicaid Services. Medicare NCCI Policy Manual, effective January 1, 2026.
https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-policy-manual - Centers for Medicare & Medicaid Services. CMS Interoperability and Prior Authorization Final Rule, CMS-0057-F.
https://www.cms.gov/newsroom/fact-sheets/cms-interoperability-prior-authorization-final-rule-cms-0057-f - North American Spine Society. Clinical Guidelines.
https://www.spine.org/Research/Clinical-Guidelines - North American Spine Society. Appropriate Use Criteria.
https://www.spine.org/Research/Appropriate-Use-Criteria - Carelon Medical Benefits Management. Current Musculoskeletal Guidelines.
https://guidelines.carelonmedicalbenefitsmanagement.com/current-musculoskeletal-guidelines/ - Carelon Medical Benefits Management. Level of Care for Surgical Procedures.
https://guidelines.carelonmedicalbenefitsmanagement.com/level-of-care-for-surgical-procedures-2025-11-15/ - eviCore by Evernorth. Musculoskeletal Advanced Procedures Clinical Guidelines.
https://www.evicore.com/provider/clinical-guidelines-details?hPlan=EviCore+by+Evernorth&solution=musculoskeletal+advanced+procedures - UnitedHealthcare. Medical and Drug Policies for Commercial Plans.
https://www.uhcprovider.com/en/policies-protocols/commercial-policies/commercial-medical-drug-policies.html - UnitedHealthcare. Medicare Advantage Medical and Drug Policies.
https://www.uhcprovider.com/en/policies-protocols/medicare-advantage-policies/medicare-advantage-medical-policies.html - Aetna. Clinical Policy Bulletin 0743, Spinal Surgery: Laminectomy and Fusion.
https://www.aetna.com/cpb/medical/data/700_799/0743.html - GoHealthcare Practice Solutions. Procedure Library.
https://www.gohealthcarellc.com/procedure-library.html - GoHealthcare Practice Solutions. Prior Authorization Overview.
https://www.gohealthcarellc.com/overview.html - GoHealthcare Practice Solutions. Revenue Integrity for Pain, Spine and MSK Specialty Care.
https://www.gohealthcarellc.com/revenue-integrity-msk-specialty-care.html
Strengthen Spine Operations Across the Entire Episode
GoHealthcare Practice Solutions supports spine practices, neurosurgery groups, orthopedic spine programs, ASCs, hospitals, and MSK organizations across patient access, prior authorization, documentation, surgical readiness, coding alignment, revenue cycle management, compliance, analytics, and healthcare AI governance.
Request HelpDeveloped by Pinky Maniri, MSc, BSc, CRCR, CSAPM, CSPPM, CSBI, CSPR, CSAF
Founder and Chief Executive Officer, GoHealthcare Practice Solutions
Certified in Healthcare A.I. Governance
https://www.linkedin.com/in/pinkymaniripescasio/