CPT 22558 · Spine Surgery · BCBS Texas
Arthrodesis, Anterior Interbody — Lumbar (ALIF/DLIF/XLIF/LLIF/OLIF) at BCBS Texas.
How BCBS Texas approaches CPT 22558 (Arthrodesis, Anterior Interbody — Lumbar (ALIF/DLIF/XLIF/LLIF/OLIF)) for prior-authorization review: at last review on 2025-09-01, the policy covers this code with prior authorization required.
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BCBSTX-MP-22558Criteria summary
High-level themes from the BCBS Texas policy of record for CPT 22558. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 12 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Blue Cross Blue Shield of Texas medical policy — Spine Surgery
See the full BCBS Texas criteria.
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