NASS announces ground-breaking tool to improve patient access to evidence-based spine care: coverage policy recommendations


In a move to improve patient access to high-quality spine care, the North American Spine Society (NASS) has revealed the first 13 of its ground-breaking coverage policy recommendations for common spine care treatments, procedures and diagnostics.

“Maintaining patient access to high-quality, evidenced-based and ethical spine care is the single most important part of NASS’ mission,” says William Watters III, NASS president. “It is our hope that payers, spine specialists and their patients will use these evidence-based coverage recommendations as a reference to advocate for appropriate care for patients.”


To develop these first-of-their kind coverage recommendations, NASS convened a multidisciplinary Coverage Task Force of spine specialists, which spent a year systematically reviewing the scientific literature and developing recommendations. Each recommendation provides the scope and clinical indications for a particular treatment or procedure. It also describes the circumstances for which that particular treatment or procedure is not indicated. Finally, the policy recommendation provides the rationale for coverage or non-coverage of a treatment or procedure, complete with references for further review. 


“This proactive approach marks an exciting shift for NASS and the entire spine field,” says Watters.


Coverage policy recommendationsare now available on the following spine treatments:


  • Cervical artificial disc replacement
  • Endoscopic discectomy
  • Epidural cervical spinal injections
  • Interspinous device without fusion
  • Interspinous fixation with fusion
  • Laser spine surgery
  • Lumbar artificial disc replacement
  • Lumbar discectomy
  • Lumbar fusion
  • Lumbar laminotomy     
  • Lumbar spinal injections
  • Percutaneous thoracolumbar stabilization
  • Recombinant human bone morphogenetic protein (rhBMP-2)



These coverage policy recommendations use an extensive evidence-based approach. In cases where high-level data may be absent or scarce, the recommendations reflect the multidisciplinary experience and expertise of the committee members to present reasonable standard practice indications in the United States.


The task force will continue to develop additional coverage recommendations, including annular repair, cervical and lumbar radiofrequency neurotomy, cervical fusion, cervical laminectomy, cervical laminoplasty, interspinous fusion with implant, intradiscal coblation treatments, lumbar laminectomy, lumbar laminotomy/foraminotomy, minimally invasive lumbar fusion, percutaneous laminectomy (eg., MILD), perineural lumbar spinal injections, SI joint fusion, SI joint injections (therapeutic and diagnostic), DNA-based scoliosis test and electrical stimulation for bone healing.


NASS will revise its coverage recommendations periodically based on the availability of new evidence-based literature and the feedback it receives from its members, patients and insurance entities.