CPT 22612 · Fusion — Posterior
Arthrodesis, Posterior — Lumbar (PLF)
Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed). Posterolateral lumbar fusion.
Free with practitioner sign-in — magic-link email auth, no credit card.
Rubrica tracks payor coverage for CPT 22612 (Arthrodesis, Posterior — Lumbar (PLF)) across 64 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 22612
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 |
| Ambetter | 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 |
Coverage themes for CPT 22612
Common patterns across the 64 payors we track. Specific criteria per payor are available after sign-in.
Most payors require ≥12 weeks of conservative care before approving 22612.
61 of 64 payors require imaging concordance documentation.
Of the 64 payors with coverage records for CPT 22612, 55 require prior authorization, 9 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.
Sign in — free for practitioners →