Anthem Medical Policies for Musculoskeletal

Document # Medical Policy Title
SURG.00052 Intradiscal Annuloplasty Procedures (Percutaneous Intradiscal Electrothermal Therapy [IDET], Percutaneous Intradiscal Radiofrequency Thermocoagulation [PIRFT] and Intradiscal Biacuplasty [IDB])
SURG.00071 Percutaneous and Endoscopic Spinal Surgery
SURG.00072 Lysis of Epidural Adhesions
SURG.00092 Implanted Devices for Spinal Stenosis
SURG.00111 Axial Lumbar Interbody Fusion
SURG.00127 Sacroiliac Joint Fusion
TRANS.00035 Mesenchymal Stem Cell Therapy for Orthopedic Indications

Code cross-reference coming soon

Soon you will be able to download a helpful spreadsheet to find current and archived codes for each solution!

Anthem medical policy site:

For a complete listing of Anthem medical policies, please go to Anthem Provider site > select your state > Scroll down page, click “See Policies and Guidelines”

Other client policy sites:

Archived Guidelines

For guidelines older than 3 years, please contact

Interventional Pain Management
Joint Surgery
  • Joint Surgery effective June 29, 2019 – May 16, 2020 for Commercial, – September 26 for Medicare members
  • Joint Surgery effective March 9, 2019 – June 28, 2019
  • Joint Surgery effective January 1, 2019 – March 8, 2019
  • Joint Surgery effective November 1, 2017 – December 31, 2018
Spine Surgery
Level of Care for Musculoskeletal Surgery and Procedures