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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

February 2017

Updates to Artificial Cervical Disc Replacement Policy

Effective April 1, 2017, Harvard Pilgrim is updating our Artificial Cervical Disc Replacement Policy to expand coverage to include two-level cervical degenerative disc disease, adding CPT 22858 as a covered service. The evidence base for two-level artificial cervical disc replacement has evolved, and as it is no longer considered experimental/investigational, for dates of service beginning April 1, 2017, Harvard Pilgrim will cover the following procedure with prior authorization:

  • 22858 – Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); second level, cervical (List separately in addition to code for primary procedure)

Ordering physicians are responsible for obtaining prior authorization. You may request prior authorization for artificial cervical disc replacement through the NIA website (www.RadMD.com) or by phone (800-642-7543).

Artificial cervical disc replacement for three or more levels (0375T) continues to be considered investigational and remains uncovered. Please refer to the updated Artificial Cervical Disc Replacement Medical Policy for Harvard Pilgrim’s clinical criteria, as well as our Spine Management and Prior Authorization online resources.

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2016 Physician Group Honor Roll Announced


Newborn Level II-IV/NICU Admission Notification Policy

Prior Authorization for Non-Emergent Transportation

Update: Expanded Coverage for Esophagogastroduodenoscopy (EGD)

GERD: Endoscopic Treatments Medical Policy Updated

Updates to Artificial Cervical Disc Replacement Policy

Reminder: 90-day Supplies at Retail

Coordinating Care to Manage Weight Gain in Behavioral Health Patients


Provider Manual Update and Balance Billing

Moderate Sedation Reimbursement for GI Endoscopic Procedures


Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator