Tennessee's Top Payer Grants Positive Coverage for Centinel Spine's prodisc® L in Lumbar Disc Replacement

Thursday, February 22, 2024

Centinel Spine®, LLC, a renowned medical device company specializing in cervical and lumbar spinal disease treatment through its prodisc® total disc replacement (TDR) technology platform, has unveiled a significant expansion of lumbar TDR coverage in Tennessee. This expansion, which takes effect on March 1, 2024, is supported by Tennessee's largest commercial payer and encompasses over 2.3 million insured individuals statewide. The coverage extension includes a favorable recommendation for both single- and two-level lumbar TDR procedures.

Notably, the coverage recommendation for two-level lumbar TDR specifically pertains to the use of the prodisc L lumbar device, which holds FDA approval for this purpose. This development represents a significant step forward in improving patient access to lumbar TDR options in Tennessee.

This expansion aligns with a broader trend observed across several states in the United States. In August 2023, major payers in Illinois, New Mexico, Oklahoma, and Texas, representing more than 16 million insured individuals, adopted Carelon's Clinical Appropriateness Guidelines-Musculoskeletal Spine Surgery Criteria, acknowledging the medical necessity of single- and two-level lumbar TDR procedures.

Similarly, in September 2023, Michigan's largest commercial payer extended coverage for single- and two-level lumbar TDR, benefiting 5.7 million insured individuals. In October 2023, North Carolina's primary commercial payer also adopted Carelon's Clinical Appropriateness Guidelines-Musculoskeletal Spine Surgery Criteria, providing lumbar TDR coverage for an additional 2.8 million insured individuals.

This collective movement towards expanded lumbar TDR coverage underscores the growing recognition and acceptance of the clinical benefits associated with total disc replacement procedures. Centinel Spine® anticipates that this trend will continue as more payers acknowledge the documented advantages of total disc replacement, ultimately benefiting patients seeking advanced spinal disease treatment options.




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