Prior Authorization Details

Cervical Fusion with Disc Removal

National Government Services will begin accepting PARs for Cervical Fusion with Disc Removal on 6/17/2021 for services provided beginning on or after 7/1/2021.

Checklist of PAR information to include:

  • Condition requiring procedure
  • Physical examination
  • Duration/character/location/radiation of pain
  • ADL limitations
  • Imaging reports pertinent to performed procedurs
  • Operative report(s) (when applicable)
  • Conservative treatment modalities include but are not limited to:
    • Physical therapy
    • Occupational therapy
    • Injections
    • Medications
    • Assistive device use
    • Activity modification

Please note: When imminent surgery is required and the medical records are submitted without conservative treatment documentation, supporting documentation must be received in the form of imaging report(s), physical findings correlated to the imaging, and the surgeon’s note(s).​​​​​​​

This checklist is not all inclusive; please submit any additional medical records that help support the medical necessity of the Hospital Outpatient Department service.

A facility or the beneficiary may submit the PAR and supplemental documentation via NGSConnex, esMD, fax or mail.

  • NGSConnex
  • Fax
    JK: 317-841-4530
    J6: 317-841-4528
  • Mail
    National Government Services, Inc.
    Attention: Medical Review Prior Authorization Request
    P.O. Box 7108
    Indianapolis, IN 46207-7108

Provider Contact Center Inquiry Line:

  • JK: 888-855-4356
  • J6: 877-702-0990

PAR decisions and the unique tracking numbers assigned for these services will be valid for 120 days. The decision date shall be counted as the first day of the 120 days. For example: if the PAR is affirmed on 7/1/2021, the PAR will be valid for dates of service through 10/28/2021. Otherwise, the provider will need to submit a new PAR.