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Payment for Lumbar Fusion Surgery rule
Payment for lumbar fusion surgery rule (OAC 4123-6-32)

This rule governs our reimbursement for lumbar fusion surgery to treat a work-related injury or occupational disease. It's not meant to preclude, or substitute for, the surgeon's responsibility to exercise sound clinical judgment considering current best medical practices when treating Ohio’s injured workers. 

BWC’s lumbar fusion rule

The rule will help to:  

  • Ensure best current clinical practices for lumbar fusion surgery when treating injured workers. 
  • Facilitate injured workers’ awareness of their treatment options for allowed lumbar conditions. 
  • Promote, at minimum, a two-month course of comprehensive, conservative care for allowed lumbar conditions unless otherwise indicated, prior to considering lumbar fusion surgery. 
  • Provide criteria for considering lumbar fusion surgery when the injured worker’s condition remains unchanged or worsens despite using conservative care. 

To develop this rule, we involved both external stakeholders and BWC staff. A subcommittee of the Health Care Quality Assurance Advisory Committee (HCQAA), which is comprised of a diverse group of health-care professionals, subject matter experts, and BWC staff, offered their suggestions and direction for the rule.

To show their support, the full HCQAAC voted unanimously to move forward on creating the rule.

Criteria for lumbar fusion surgery 

Our lumbar fusion rule allows informed decision making for those considering undergoing lumbar fusion surgery and provides communication among the physician of record (POR) or treating physician, injured worker, and operating surgeon. Also, the injured worker and either the POR, treating physician, or the operating surgeon, must sign the rule appendix, What BWC Wants You to Know About Lumbar Fusion Surgery.

In addition, the operating surgeon must see the injured worker at least two times prior to the worker electing to have lumbar fusion surgery. 

For more information, view our Non-Emergent Lumbar Fusion Protocols fact sheet.