CPT 22558 · Spine Surgery · Horizon BCBS NJ
Arthrodesis, Anterior Interbody — Lumbar (ALIF/DLIF/XLIF/LLIF/OLIF) at Horizon BCBS NJ.
How Horizon BCBS NJ approaches CPT 22558 (Arthrodesis, Anterior Interbody — Lumbar (ALIF/DLIF/XLIF/LLIF/OLIF)) for prior-authorization review: at last review on 2026-05-02, the policy covers this code with prior authorization required.
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Carelon-Spine-2026Criteria summary
High-level themes from the Horizon BCBS NJ 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: Carelon Clinical Appropriateness Guidelines — Spine Surgery / per-plan medical policy
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