Health insurance coverage of lumbar total disc replacement (TDR) has improved over the last year. Your health plan may cover lumbar TDR. To determine that, please review the list of insurers covering. Insurers >
Please be sure to discuss your individual case with a surgeon to assess whether it will meet your insurer’s criteria.
If your health plan does not cover lumbar TDR, we strongly encourage you to contact our activL® Artificial Disc Patient Assistance Line (PAL) for support with your case.
PAL Support
What Can PAL Do to Help Me with Coverage?
If you meet all of the criteria for the activL Artificial Disc, and your insurance company is denying coverage for the device, PAL can help appeal your case through an independent, external review. External review organizations can overturn denials if they feel that the case warrants individual coverage.
What Do I Need to Do to Work with PAL?
Once you have been identified as a lumbar TDR candidate, either your surgeon or you may contact PAL at:
Monday through Friday, 9:00 am - 6:00 pm ET
Tel: 844-245-1140
Fax: 844-285-1330
Email: cynthia@patientassistanceline.com
PAL will send you two forms for signature to enable them to work with you and your insurance company directly.
Patient Authorization for Use or Disclosure of Protected Health Information to Rollins Advocacy & Consulting, LLC >
Designation of Personal Representative-For Use and Disclosure of Protected Health Information (PHI) >
Once all of the forms are received from you and from your surgeon’s office, they will submit your case for appeal.
How Long Does This Process Take?
On average, the process takes three months. You may decide at any point during the appeal to change your mind. PAL will keep you updated at every stage.
Do You Have Any Information About This That I Can Take to My Surgeon?
Yes, the activL Artificial Disc Patient Brochure is attached, which you are welcome to download and show your surgeon.
activL Patient Information Brochure - Spike Endplate >
activL Patient Information Brochure - Keel Endplate >
activL Patient Information Brochure - Spanish >
Summary of Medical Policy for Lumbar Total Disc Replacement >
* The coding and reimbursement information and data provided by Aesculap Implant Systems, LLC is presented for informational purposes only and is accurate as of its date of publication. Healthcare providers are responsible for all decisions related to documenting, coding, reporting/billing, and pre-authorizing procedures. It is the healthcare provider's responsibility to report only the codes which accurately describe the products and services furnished to individual patients. Reimbursement is dynamic; laws and regulations related to reimbursement change frequently. For these reasons, healthcare providers are advised to contact Medicare or any other specific payer if they have any questions regarding coding, coverage, or payment for items or services. If Providers have questions regarding coding, they should refer to the current HCPCS and/or CPT® manual or contact the appropriate Medical Society or the American Medical Association (AMA). Aesculap Implant Systems, LLC makes no representation or warranty regarding this information, its completeness or accuracy and bears no responsibility for the results or consequences of the use of this information. (CPT® codes and descriptors are copyrighted by the AMA.)
Indications for Use
The activL® Artificial Disc is indicated for reconstruction of the disc at one level (L4-L5 or L5-S1) following single-level discectomy in skeletally mature patients with symptomatic degenerative disc disease (DDD) with no more than Grade I spondylolisthesis at the involved level. DDD is defined as discogenic back pain with degeneration of the disc confirmed by patient history, physical examination, and radiographic studies. The activL Artificial Disc is implanted using an anterior retroperitoneal approach. Patients receiving the activL Artificial Disc should have failed at least six months of nonoperative treatment prior to implantation of the device.
Rx only.
For complete prescribing information please see the Instructions For Use at
www.aesculapimplantsystems.com/instructions-for-use-spine
Contraindications, Warnings and Precautions
- The activL Artificial Disc should not be implanted in patients with the following conditions:
- Active systemic infection or localized infection near the surgical site.
- Osteoporosis or osteopenia defined as dual-energy X-ray absorptiometry (DEXA) bone mineral density T-score less than or equal to -1.0
- Allergy or sensitivity to the implant materials (cobalt, chromium, polyethylene, titanium, tantalum, or calcium phosphate)
- Isolated radiculopathy, especially due to herniated disc
- Chronic radiculopathy (unremitting pain with predominance of leg pain symptoms greater than back pain symptoms extending over a period of at least a year)
- Extruded disc material with sequestrum (i.e., free disc fragment)
- Myelopathy
- Spinal stenosis
- Spinal deformity such as scoliosis
- Spondylolysis/isthmic spondylolisthesis, degenerative spondylolisthesis > Grade I, or segmental instability
- Clinically compromised vertebral bodies at the affected level due to current or past trauma (e.g., current or prior vertebral fracture) or disease (e.g., ankylosing spondylitis)
- Facet ankylosis or facet joint degeneration
- Preoperative remaining disc height < 3 mm
- Symptoms attributed to more than one vertebral level
- Abdominal pathology that would preclude an anterior retroperitoneal approach
- Involved vertebral endplates dimensionally smaller than 31 mm in the medial-lateral and/or 26 mm in the anterior-posterior directions