WEST CHESTER, PA — Centinel Spine®, LLC recently announced significant expansion to patient access for the prodisc® L Lumbar Total Disc Replacement (TDR) system. An additional 22 million lives will now be covered as the result of an update to medical necessity guidelines by Aetna® to include a positive coverage policy recommendation for one-level lumbar TDR.
Aetna is one of the largest commercial insurers in the U.S. and previously had a coverage policy that considered one-level lumbar TDR “experimental and investigational” and thus not covered. The new positive coverage policy opens access to patients suffering from one-level symptomatic degenerative disc disease (DDD) who may benefit from total disc replacement using a technology such as prodisc L. With Aetna’s coverage update, all major commercial payors now cover one-level lumbar TDR.
“This announcement reaffirms the strong clinical and radiographic outcomes found in patients implanted with lumbar total disc replacements,” stated Jack Zigler, MD, Texas Back Institute. Dr. Zigler and his partners have implanted over 3,000 lumbar TDRs since the year 2000, with overall excellent clinical results. Continuing, Dr. Zigler commented, “Backed by layers of published Level I data demonstrating the long-term effectiveness of lumbar TDR over the last 23 years, lumbar TDR has some of the most compelling clinical evidence of any technology that is used to improve the quality of patients’ lives.”
“This is outstanding news for patients,” noted Centinel Spine CEO Steve Murray. “In addition to allowing the prodisc L Lumbar TDR system to be available to as many as 22 million new patients, this update means that all major U.S. payors now cover this technology for one level. Commercial coverage for one-level lumbar TDR has significantly expanded in recent years and the Aetna decision brings the total amount of covered lives in the US to over 95%. This coverage expansion represents not only an excellent opportunity for surgeons to provide more patients with a broader spectrum of treatment options, but to ensure that patients have access to the best spine care possible.”
In addition to expanded one-level lumbar TDR coverage, patient access and treatment with the prodisc L Lumbar TDR system continues to advance in additional areas. Effective January 1, 2023, providers began to utilize a new Current Procedural Terminology (CPT®) code when performing two-level lumbar total disc arthroplasty via an anterior approach. Centinel Spine’s prodisc L is the only FDA-approved TDR system in the U.S. for two-level use in the lumbar spine. The Company has also recently launched prodisc L Anatomic Endplates—designed to shift the lordotic angle of the lumbar implant to the inferior endplate.
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