National Imaging Associates (NIA), a Magellan Health Company, Updates Clinical Guidelines for Medical Necessity to Include a Recommendation of Lumbar Total Disc Replacement 

Center Valley, PA (July 7, 2020) - Aesculap Implant Systems, LLC today announced that National Imaging Associates (NIA), a Magellan Health Company, has updated its “Clinical Guidelines for Medical Necessity for Musculoskeletal and Surgery” to include a medical necessity recommendation for Lumbar Total Disc Replacement (TDR), including the latest generation activL^® Artificial Disc. 

Multiple U.S. commercial payers including Hawaii Medical Service Association (HMSA), Florida Blue, Harvard Pilgrim Health Care, Tufts Health Plan and Dean Health Plan follow NIA Magellan’s clinical coverage guidelines, and, therefore, NIA’s recent update potentially opens the door for positive coverage to more than 8.5 million American commercial health insurance beneficiaries. NIA Magellan provides a third-party prior authorization service to U.S. insurers. According to the company’s website, the service delivers cost savings to the payers by taking over the burden of clinical analytics, and their due diligence leads them to recommend evidence-based practices that result in “better quality and bottom-line outcomes” for health plans. 

“For several years, we have noted that NIA Magellan had outdated references in their clinical guidelines for Lumbar Total Disc Replacement,” said Kim Norton, reimbursement consultant for Aesculap Implant Systems and V.P. of Reimbursement for Simplify Medical. “It took us several tries to get this issue in front of the right decision makers, so we were pleased to see that they were able to objectively review the strong evidence for lumbar TDR and update their guidelines based on that.” 

NIA Magellan’s new guideline leans on a Cochrane Review (2013), the 2019 North American Spine Society (NASS) Coverage Policy Recommendation and a level-one meta-analysis of randomized controlled clinical trial outcomes by Dr. Jack Zigler and Dr. Matthew Gornet (2017) to shape the positive recommendation for lumbar TDR.