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LCD L37826: Lumbar Artificial Disc Replacement

LCD L37826, Lumbar Artificial Disc Replacement, is the Local Coverage Determination that Palmetto GBA applies to claims from 7 states (AL, GA, NC, SC, TN, VA, WV), effective 2024-09-12 and first in force 2019-05-06. The policy text runs 237 words. No other contractor publishes a policy with this title.

QuickIntell editorial content · Legacy registry date · Review not verified

Data effective
Data currency: Medicare Coverage Database LCD export release of September 24, 2026 (effective September 20, 2026). Next CMS release: weekly (Thursdays) for the MCD.
Contractor
Palmetto GBA
States and territories
7
AL GA NC SC TN VA WV
Revision effective
2024-09-12
Original effective
2019-05-06
Policy text
237 words
Covered ICD-10 codes (articles)
0

Where this LCD applies

Each contract number is a jurisdiction on the remittance; the policy binds claims processed under these contracts and no others.

Contracts that apply LCD L37826
ContractContractorTypeStates
11201Palmetto GBAA and B and HHH MACSC
11301Palmetto GBAA and B and HHH MACVA
11401Palmetto GBAA and B and HHH MACWV
11501Palmetto GBAA and B and HHH MACNC
11202Palmetto GBAA and B and HHH MACSC
11302Palmetto GBAA and B and HHH MACVA
11402Palmetto GBAA and B and HHH MACWV
11502Palmetto GBAA and B and HHH MACNC
10111Palmetto GBAA and B MACAL
10211Palmetto GBAA and B MACGA
10311Palmetto GBAA and B MACTN
10112Palmetto GBAA and B MACAL
10212Palmetto GBAA and B MACGA
10312Palmetto GBAA and B MACTN

Billing and coding: diagnoses and procedure codes

Since 2019 the codes live in the companion article rather than the LCD. Billing and Coding A56390 (Billing and Coding: Lumbar Artificial Disc Replacement) carries the diagnosis and procedure lists the contractor loads as the claims edit. CPT codes are shown as bare numbers because the descriptors are licensed by the AMA; HCPCS Level II descriptors are public and shown.

A56390: Billing and Coding: Lumbar Artificial Disc Replacement (Billing and Coding, effective 2023-01-01)

Covered ICD-10-CM codes
0
0 groups
Non-covered ICD-10-CM codes
0
Procedure codes listed
4
Full article
cms.gov record

Procedure codes: 0165T, 22857, 22860, 22862.

Coverage indications, limitations and medical necessity

Definitions and Scope

This is a non-coverage Local Coverage Determination (LCD) for lumbar artificial disc replacement in beneficiaries 60 years of age and younger. National Coverage Determination (NCD) 150.10 makes lumbar artificial disc replacement a non-covered service for beneficiaries over 60 years of age. For beneficiaries age 60 years and younger, the NCD leaves the determination to local Medicare Administrative Contractors (MACs). This A/B MAC has determined that lumbar artificial disc replacement is not reasonable and necessary in beneficiaries 60 years of age and younger. Revision of a previously placed artificial disc is, therefore, also not covered. Artificial disc removal without prosthetic disc revision is not discussed by this LCD.

Background

Lower back pain is a common condition that can be caused by a number of structures in the spine, 1 of which is the intervertebral disc. For patients who have degenerative disc disease (DDD) at a single level to which their back pain is attributed and which has not responded to conservative treatment, disc replacement (also referred to as total disc arthroplasty) has been proposed as a potential treatment. The goal is to replace the degenerated disc with an artificial disc, which will not cause pain while hopefully maintaining range of motion as much as possible. A number of artificial discs have been developed for the lumbar spine, some of which have been introduced into the United States as Food and Drug Administration (FDA) approved devices.

Summary of evidence (opening)

For the purposes of coverage policy, a meaningful benefit in human subjects must be demonstrated. This MAC considers a clinically meaningful benefit to be a change in symptoms evident to the patient as he or she goes about daily life. As such, while lumbar artificial discs may preserve range of motion, range of motion preservation does not itself make a treatment reasonable and necessary. Only studies designed to assess clinical outcomes or composite outcomes that included at least 1 clinical measure were considered relevant to this coverage determination. Studies that strictly assessed biomechanics, radiographic changes, or other strictly physiologic effects were not evaluated and are not considered relevant to coverage determination.

A number of artificial discs are available in the United States with different indications, and much of the literature is device-specific, so this summary will categorize the evidence by device. As will be reviewed below, lumbar disc replacement appears to be regarded as an alternative treatment approach to fusion, which in itself is not considered in this LCD.

CHARITÉ ® and INMOTION ®

The first artificial disc to be FDA approved for use in the lumbar spine was the CHARITÉ ® artificial disc. CHARITÉ ® was subsequently replaced by the INMOTION ® artificial disc, which was approved under the CHARITÉ ® Artificial Disc Registration. CHARITÉ ® received a FDA premarket approval decision on 10/26/2004, but has subsequently been officially withdrawn on 1/5/2012 (FDA CHARITÉ ® 1). While CHARITÉ ® and INMOTION ® artificial disc systems are unavailable for routine clinical use in the United States currently, the clinical research done on this device family is reviewed for its relevance to artificial disc replacement in general.

the full summary and analysis of evidence are in the CMS record.

Dates, lineage and related policies

Original determination effective
2019-05-06
Current revision effective
2024-09-12
Last reviewed by the contractor
2024-06-07
MCD version
28

The contractor lists one National Coverage Determination as related: NCD 150.10 Lumbar Artificial Disc Replacement (LADR). Where an NCD speaks, it controls; the LCD can only address what the NCD leaves open.

Other related documents: A56393 (Response to Comments).

Using this policy on a claim

Match the documented indication to the covered indications above before the service is scheduled, carry a diagnosis from the article's covered list on the claim line, and keep the elements the documentation section asks for in the record, because the contractor can request it later through medical review. A denial under this policy arrives as CARC 50 with remark N115; the LCD lookup guide walks through the appeal path and the Advance Beneficiary Notice rules, and the Palmetto GBA hub lists every other active policy from the same contractor.

Frequently asked questions

What does LCD L37826 cover?

This is a non-coverage Local Coverage Determination (LCD) for lumbar artificial disc replacement in beneficiaries 60 years of age and younger. National Coverage Determination (NCD) 150.10 makes lumbar artificial disc replacement a non-covered service for beneficiaries over 60 years of age. For beneficiaries age 60 years and younger, the NCD leaves the determination to local Medicare Administrative Contractors… The full indications and limitations are reproduced on this page from the CMS Medicare Coverage Database export of September 24, 2026.

Which states does LCD L37826 apply to?

Palmetto GBA applies it to Medicare claims in AL, GA, NC, SC, TN, VA, WV. A Local Coverage Determination binds only the contractor that wrote it; the same service in another jurisdiction is judged under that contractor's own policy or, where none exists, claim by claim.

Which diagnosis codes support medical necessity under LCD L37826?

The current export links no billing and coding article with a diagnosis list to this LCD, so coverage is decided on the indications in the policy text and the documentation in the record rather than by an automated diagnosis edit.

How do I appeal a denial under LCD L37826?

The remittance carries claim adjustment reason code 50 with remark code N115, naming the LCD. Compare the documented indication with the policy's covered indications and the article's diagnosis list, then file a redetermination within 120 days with the record attached; if the service genuinely falls outside the policy, the patient can be billed only when a valid Advance Beneficiary Notice was obtained before the service.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.

Disclaimer

The policy text and code lists are reproduced from the CMS Medicare Coverage Database export as an operational reference. Verify against the current LCD and article on cms.gov before billing; coverage depends on the full record and the contractor. Not legal, clinical or billing advice.