CPT 22612 · Spine Surgery · Anthem BCBS
Arthrodesis, Posterior — Lumbar (PLF) at Anthem BCBS.
How Anthem BCBS approaches CPT 22612 (Arthrodesis, Posterior — Lumbar (PLF)) for prior-authorization review: at last review on 2025-09-01, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2025-09-01
Policy number
CG-SURG-22612Criteria summary
High-level themes from the Anthem BCBS policy of record for CPT 22612. 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: Anthem (Elevance Health) medical policy — Spine Surgery
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