Diagnosis: Back pain.
Treatment: VIA Disc NP (Procedure Code 0627T).
The insurer denied VIA Disc NP (Procedure Code 0627T).
The health plan's determination is upheld.

The patient is a female with complaints of chronic low back pain. The pain is in the midline. Imaging demonstrates disc degeneration at the L (lumbar) 4-L5 level. Pain impacts activities of daily living (ADL). She has trialed tramadol as well as muscle relaxants. Prior treatments have included physical therapy as well as injections.

The VIA Disc is not likely to be more beneficial than any standard treatment or treatments for the insured's life threatening or disabling condition or disease.
The provider is requesting Via Disc NP for lumbar degenerative disc disease. This type of procedure is not recommended due to lack of support in the medical literature. The research has been fraught with bias and sloppiness. Major questions remain unanswered regarding the best cell type and origin (peripheral blood, bone marrow, fat, or even allogeneic umbilical cord), cell dosage, timing, single versus multiple treatments, and carrier biomaterials (hyaluronic acid, tissue scaffolds). Overall, VIA Disc is not likely to be more beneficial than any standard treatment or treatments for the insured's life threatening or disabling condition or disease.