Lumbar Artificial Disc Replacement (LADR)
Upon completion of a national coverage analysis for reconsideration of the
national coverage determination for LADR, the decision was made that LADR is non-covered for Medicare
beneficiaries over 60 years of age. This reconsideration decision reflects the change from non-coverage for
a specific LADR implant (the Charite) to non-coverage for the LADR procedure for the Medicare
population over 60 years of age.
This revision of section 150.10, of Pub.100-03, is a national coverage determination (NCD). NCDs are
binding on all carriers, fiscal intermediaries, quality improvement organizations, qualified independent
contractors, the Medicare Appeals Council, and administrative law judges (ALJs) (see 42 CFR section
405.1060(a)(4) (2005)). An NCD that expands coverage is also binding on a Medicare advantage
organization. In addition, an ALJ may not review an NCD. (See section 1869(f)(1)(A)(i) of the Social
Security Act.)
Final
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 11, 2007
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.