CPT 22558 · Spine Surgery · Cigna
Arthrodesis, Anterior Interbody — Lumbar (ALIF/DLIF/XLIF/LLIF/OLIF) at Cigna.
How Cigna approaches CPT 22558 (Arthrodesis, Anterior Interbody — Lumbar (ALIF/DLIF/XLIF/LLIF/OLIF)) for prior-authorization review: at last review on 2025-04-01, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2025-04-01
Policy number
CMM-325Criteria summary
High-level themes from the Cigna 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: Cigna Medical Coverage Policy — Spinal Surgery (CMM-325)
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