Which Cervical Artificial Disc Devices Medicare Will Cover

What Medicare Covers for Cervical Artificial Discs

Medicare covers cervical artificial disc replacement (also called cervical disc arthroplasty) under specific conditions, but not all devices are covered and not all surgeons can perform the procedure under Medicare payment. Medicare's coverage applies to two FDA-approved devices: the Prestige ST and the ProDisc-C. Both must be implanted by a surgeon at a hospital or surgical center that has enrolled in Medicare, and the procedure must meet Medicare's medical necessity rules.

The key difference from other spine surgeries is that Medicare treats artificial disc replacement as a newer procedure with stricter rules than traditional cervical fusion. You will need prior authorization from Medicare before surgery — your surgeon's office typically handles this, but the process can take one to two weeks. If your surgeon uses a device Medicare does not cover, or if the procedure does not meet Medicare's criteria, you will be responsible for the full cost.

Key Takeaways

Medicare covers only the Prestige ST and ProDisc-C cervical artificial discs, and only when implanted at a Medicare-enrolled facility by a participating surgeon.
Your surgeon must obtain prior authorization from Medicare before the procedure, which typically takes one to two weeks and requires medical records showing conservative treatment has failed.
Medicare requires that you have had neck pain or arm pain for at least six months and tried physical therapy or other non-surgical treatment before approving the surgery.
If your surgeon uses an unapproved device or performs the procedure at a non-participating facility, Medicare will not pay and you will owe the entire bill.
Your out-of-pocket cost under Original Medicare is typically 20 percent of the approved amount after you meet your Part B deductible, but this varies if you have a Medigap or Medicare Advantage plan.

The Two Devices Medicare Covers

The Prestige ST (made by Medtronic) and the ProDisc-C (made by Synthes) are the only two cervical artificial discs with Medicare coverage. Both are FDA-approved and designed to replace a damaged disc while allowing the neck to move more naturally than a fusion would. Other devices exist and may be FDA-approved, but Medicare does not cover them, which means the hospital or surgeon would bill you for the device cost even if Medicare pays for the surgery itself.

Before your surgery, ask your surgeon which device they plan to use and confirm it is one of these two. If they mention a different device — such as the Mobi-C, the Kineflex, or any other model — check with Medicare or your insurance plan before proceeding. Some Medicare Advantage plans may have different coverage rules than Original Medicare, so contact your plan directly if you are enrolled in one.

Medicare's Medical Necessity Requirements

Medicare will not pay for cervical artificial disc replacement unless your case meets several conditions. You must have had neck pain, arm pain, or both for at least six months. You must have tried and failed conservative treatment — typically physical therapy, anti-inflammatory medications, or steroid injections — for at least three months. Your imaging (MRI or CT scan) must show a single-level disc herniation or degeneration that matches your symptoms, and the condition must be causing nerve compression or myelopathy (spinal cord damage).

You cannot have had previous fusion surgery at the same level of the spine. You cannot have severe osteoporosis, active infection, or certain other spine conditions. Medicare also requires that your surgeon document that fusion surgery (the traditional alternative) would be less effective for your specific situation. Your surgeon's office should know these rules and will include this documentation when requesting prior authorization.

How to Get Prior Authorization from Medicare

Your surgeon's office is responsible for requesting prior authorization, but you should confirm they have done so at least two weeks before your scheduled surgery date. The authorization request goes to Medicare's contractor for your state (not to Medicare directly). The contractor reviews your medical records, imaging, and the surgeon's notes to determine whether the procedure meets Medicare's criteria.

You can ask your surgeon's office for the authorization request number and check the status yourself by calling Medicare at 1-800-MEDICARE. If Medicare denies the request, your surgeon can appeal, and you have the right to appeal as well. Do not assume authorization has been granted — confirm it in writing before the day of surgery. If authorization is denied and you proceed anyway, you will receive a bill for the full cost of the procedure.

Your Out-of-Pocket Costs Under Original Medicare

If Medicare approves the procedure, your cost depends on whether you have Original Medicare or a Medicare Advantage plan. Under Original Medicare, you pay 20 percent of the approved amount for the surgery and facility costs after you meet your Part B deductible (which is $240 in 2024, though this amount changes yearly). The approved amount for cervical artificial disc replacement varies by region and facility, typically ranging from $15,000 to $25,000 for the surgery and facility fees alone, not including the device.

The device itself is usually bundled into the facility payment, so you do not pay separately for it. However, if the facility is out-of-network or if you receive care from an out-of-network surgeon, your costs will be higher. If you have a Medigap plan, it may cover some or all of your 20 percent coinsurance. If you have a Medicare Advantage plan, your costs depend on your plan's rules — some plans cover the procedure in full after a copay, while others may not cover it at all.

What Happens If Your Surgeon Uses an Unapproved Device

If your surgeon implants a device that Medicare does not cover, Medicare will still pay for the surgery and facility costs if prior authorization was obtained and the medical necessity criteria were met. However, you will receive a separate bill from the hospital or device manufacturer for the device itself. This bill can range from $5,000 to $15,000 or more, depending on the device.

Before surgery, ask your surgeon in writing which device they will use and confirm it is either the Prestige ST or ProDisc-C. If they cannot confirm this, ask why and whether an alternative device is necessary for your specific case. Some surgeons may recommend a different device because they believe it is better suited to your anatomy, but you have the right to understand the cost difference and make an informed decision.

Medicare Advantage Plans and Cervical Artificial Disc Coverage

Medicare Advantage plans (Part C) are required to cover at least what Original Medicare covers, but they can add restrictions or require higher out-of-pocket costs. Some Medicare Advantage plans require prior authorization through the plan itself in addition to Medicare's authorization. Others may require you to use in-network surgeons or facilities, or may limit coverage to certain devices or hospitals.

Contact your Medicare Advantage plan before your surgeon requests prior authorization from Medicare. Ask whether the plan covers cervical artificial disc replacement, which devices are covered, and whether you need the plan's approval in addition to Medicare's. If your plan denies coverage or imposes a high out-of-pocket cost, you have the right to appeal the decision. You can also switch to Original Medicare during the annual open enrollment period if your plan's coverage is too restrictive.

Frequently Asked Questions

Will Medicare cover cervical artificial disc replacement if I have already had fusion surgery?

No. Medicare does not cover artificial disc replacement at a level where you have already had fusion surgery. If you had fusion at a different level of your spine, artificial disc replacement at another level may be covered if you meet all other criteria. Ask your surgeon whether your previous surgery affects your current case.

What if my surgeon says the Prestige ST or ProDisc-C will not work for my anatomy?

If your surgeon believes one of the covered devices is not suitable for your case, they can request a coverage exception from Medicare. This requires detailed medical documentation explaining why the covered devices would not work and why an alternative device is medically necessary. Medicare reviews these requests but denies most of them. Ask your surgeon whether they have successfully obtained exceptions in the past.

Can I get cervical artificial disc replacement at an outpatient surgery center, or does it have to be at a hospital?

Cervical artificial disc replacement can be performed at either a hospital or an ambulatory surgery center, as long as the facility is Medicare-enrolled. Ask your surgeon where the procedure will take place and confirm the facility accepts Medicare. Outpatient surgery centers may have lower facility costs than hospitals, which could reduce your out-of-pocket expense.

What if Medicare denies prior authorization for my surgery?

You and your surgeon both have the right to appeal a denial. Your surgeon can submit additional medical records or a detailed letter explaining why your case meets Medicare's criteria. You can also request a peer-to-peer review, where your surgeon speaks directly with a Medicare medical reviewer. The appeal process typically takes two to four weeks. Do not schedule surgery until the appeal is resolved.

Does my Medigap plan cover the 20 percent coinsurance for cervical artificial disc replacement?

Most Medigap plans cover some or all of your Part B coinsurance, but the amount varies by plan type. Check your Medigap plan documents or call your plan to confirm coverage for this specific procedure. If your plan covers it, you may owe only your Part B deductible, with the plan paying the rest.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.