Medicare (CMS LCD/NCD) Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures prior authorization requirements (2026)
What Medicare (CMS LCD/NCD) generally requires to approve Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures (CPT 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63032, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63200, 63265, 63266, 63267), for Medicare plans. Yes. Medicare (CMS LCD/NCD) generally requires prior authorization for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures (CPT 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63032, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63200, 63265, 63266, 63267).
Medical-necessity criteria Medicare (CMS LCD/NCD) generally applies
Covered for symptomatic lumbar spinal stenosis with neurogenic claudication (leg pain, numbness, or weakness worse with standing/walking and relieved by sitting or forward flexion) confirmed by imaging (MRI, CT, or myelogram) and unresponsive to conservative therapy. Documentation must show imaging-confirmed stenosis correlating with symptoms and the failed conservative measures attempted.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures. Confirm the covered diagnosis list against the current Medicare (CMS LCD/NCD) policy.
Source
Source: CMS NCA Percutaneous Image-guided Lumbar Decompression (CAG-00433N) and regional laminectomy/decompression LCDs. Last verified 2026-06-10.
Frequently asked questions
Does Medicare (CMS LCD/NCD) require prior authorization for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures?
Yes. Medicare (CMS LCD/NCD) generally requires prior authorization for Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures (CPT 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63032, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63200, 63265, 63266, 63267).
What does Medicare (CMS LCD/NCD) require to approve Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures?
Covered for symptomatic lumbar spinal stenosis with neurogenic claudication (leg pain, numbness, or weakness worse with standing/walking and relieved by sitting or forward flexion) confirmed by imaging (MRI, CT, or myelogram) and unresponsive to conservative therapy. Documentation must show imaging-confirmed stenosis correlating with symptoms and the failed conservative measures attempted. Always confirm against the current Medicare (CMS LCD/NCD) policy.
How long does a Medicare (CMS LCD/NCD) prior authorization take?
Turnaround varies by plan and submission method. Check the Medicare (CMS LCD/NCD) portal for current timeframes.
Submitting Cervical, Lumbar and Thoracic Laminectomy and/or Laminotomy Procedures to Medicare (CMS LCD/NCD)?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.