BCBSMI – 1st Private Payer to Cover Paradigm Spine’s Coflex

September 2017 ~

A medical policy from Blue Cross Blue Shield of Michigan marks the first commercial payer to issue a positive coverage policy for a new lumbar spinal stenosis (LSS) treatment.

Announced by Paradigm Spine, the new medical policy titled “Interspinous/Interlaminar Stabilization/Distraction Devices (Spacers)” offers coverage of the Coflex® Interlaminar Stabilization® implant procedure.

Interspinous spacers are devices implanted between vertebral spinous processes. Interlaminar spacers are implanted between adjacent lamina and have two sets of wings that are placed around the inferior and superior spinous processes. These implants aim to restrict painful motion while otherwise enabling normal motion. The devices (spacers) distract the laminar space and/or spinous processes and restrict extension. This procedure theoretically enlarges the neural foramen and decompresses the cauda equina in patients with spinal stenosis and neurogenic claudication.

Traditional treatment for LSS includes decompression and possibly fusion. Coflex provides a non-fusion, motion preserving stabilization option and is premarket approved to treat LSS. It can be used with a decompression or in lieu of spinal fusion.

The implementation of this policy represents the first private payor positive coverage policy for a novel, proven treatment for LSS. The policy covers 4.5 million BCBSMI patients in addition to the 4.1 million already covered by Medicare, Medicaid and the U.S. Federal statute.


Source(s): Paradigm Spine LLC; Becker’s Spine Review; Blue Cross Blue Shield of Michigan; OrthoWorld;