WEST CHESTER, PA — Centinel Spine®, LLC announced a significant expansion of coverage for lumbar TDR procedures in Michigan. The policy expansion announced by Michigan’s largest commercial payer—effective September 1, 2023— represents over 5.8 million covered lives across the state and includes a positive coverage recommendation for both one- and two-level lumbar TDR. This major positive coverage update continues the trend for one-level lumbar TDR over the last several years, moving the number of covered lives from under 50% in 2017 to now approaching universal coverage for commercial payers.
The expanded coverage policy specifically references Centinel Spine’s prodisc® L system, the only TDR system in the U.S. approved for one- and two-level use in the lumbar spine. Additional policy addenda outline coverage for the L3-L4 lumbar level; prodisc L remains the only TDR system in the U.S. approved for use at the L3-L4 level. The commercial payer, the largest operating payer in Michigan, previously had no coverage policy for either one- or two-level lumbar TDR. The new positive coverage policy opens access to patients suffering from symptomatic degenerative disc disease (DDD) who can benefit from lumbar TDR using prodisc L for both one- and two-level lumbar TDR.
According to John F. Keller, MD, Neurosurgeon, Great Lakes Neurosurgical Associates, “This most recent announcement expands disc replacement coverage benefits to over half of the patients we see in my practice, providing them with access to a motion-sparing alternative to fusion in the lumbar spine. We appreciate that more and more commercial payers now recognize and value the extensive existing clinical evidence and ongoing long-term outcome publications that demonstrate that one- and two-level lumbar total disc arthroplasty is a safe and effective procedure. I anticipate this coverage expansion may lead many of my patients that have been avoiding fusion to reconsider their surgical options to obtain a higher quality of life.”
Centinel Spine CEO Steve Murray shared, “This reversal from non-coverage to coverage by such a large commercial payer continues a trend in positive coverage decisions for prodisc L over the last several years. This is a major positive coverage change that more than doubles the number of covered lives in Michigan and brings total one-level lumbar TDR coverage in the U.S. to almost 95%. We have seen an immediate response by surgeons and patients, leading to continued strong growth in prodisc L cases in the last two years.”
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