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