CPT 22558 · Fusion — Anterior
Arthrodesis, Anterior Interbody — Lumbar (ALIF/DLIF/XLIF/LLIF/OLIF)
Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar. Includes ALIF, DLIF, XLIF, LLIF, OLIF approaches.
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Rubrica tracks payor coverage for CPT 22558 (Arthrodesis, Anterior Interbody — Lumbar (ALIF/DLIF/XLIF/LLIF/OLIF)) across 60 payors — every Medicare MAC, the major commercial plans, the BCBS family, all 50-state Medicaid programs, and selected workers' comp and auto/PIP carriers. Aggregate coverage patterns are shown below; full payor-specific criteria, source citations, and last-reviewed dates are available to signed-in practitioners.
Top payors covering CPT 22558
Sample of 12 payors with coverage for this code. Sign in for the complete payor list, verbatim criteria, denial-risk score, and source citations for each.
| Payor | Coverage | Prior auth |
|---|---|---|
| Aetna | Covered | Prior auth |
| Aetna Medicare Advantage | Covered | Prior auth |
| Anthem BCBS | Covered | Prior auth |
| BCBS Alabama | Covered | Prior auth |
| BCBS Federal Employee Program | Covered | Prior auth |
| BCBS Illinois | Covered | Prior auth |
| BCBS Massachusetts | Covered | Prior auth |
| BCBS Michigan | Covered | Prior auth |
| BCBS Montana | Covered | Prior auth |
| BCBS New Mexico | Covered | Prior auth |
| BCBS Oklahoma | Covered | Prior auth |
| BCBS Tennessee | Covered | Prior auth |
Coverage themes for CPT 22558
Common patterns across the 60 payors we track. Specific criteria per payor are available after sign-in.
Most payors require ≥12 weeks of conservative care before approving 22558.
57 of 60 payors require imaging concordance documentation.
Of the 60 payors with coverage records for CPT 22558, 49 require prior authorization, 11 cover without prior authorization, and 0 flag the procedure as investigational or experimental under current criteria.
See the policy for every payor.
Sign in to see verbatim coverage criteria, conservative-care duration requirements, imaging concordance rules, and the documentation each payor wants in the submission.
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