Criteria categories needed for coverage by recommendation set.
| Categorya | NASS | Evicore | AIM | Orthonet | Lifetime Health Care | UPMC | Aetna | United |
| Radiculopathy/claudication | Y | Y | Y | N/A | Y | Y | Y | Y |
| Correlative lesion on imaging? | Y | Y | Y | N/A | Y | Y | Y | Y |
| Degree of stenosis specified? | N | N | N | N/A | N | N | Y | N |
| Duration of symptoms requirement? | Y | N | N | N/A | N | N | N | Y |
| Physical examination findings? | N | N | Y | N/A | Y | Y | N | N |
| Documented physical examination? | N | Y | Y | N/A | N | N | N | N |
| Exclude untreated psychiatric patients? | N | Y | N | N/A | Y | N | Y | N |
| Pain threshold? (On 10-point VAS scale) | N | 7 | 3 | N/A | 7 | N | N | N |
| Epidural injection necessary? | N | N | N | N/A | N | Y | N | N |
| Physical therapy necessary? | N | N | Y | N/A | N | Y | N | N |
| Duration of conservative management? | 4 wk | 6 wk | 6 wk | N/A | 6 wk | 12 wk | 6 wk | 4 wk |
| Mandate a trial of medical treatment? | N | N | N | N/A | N | Y | N | N |
| Total categories needed for coverage | 4 | 6 | 7 | N/A | 5 | 7 | 5 | 4 |
Abbreviations: AIM, American Imaging Management; N/A, not available; NASS, North American Spine Society; UPMC, University of Pittsburgh Medical Center; VAS, visual analog scale.
↵a Subcategories required for coverage of surgical intervention.