CPT 22612 · Other Procedure · BCBS Montana
Arthrodesis, Posterior — Lumbar (PLF) at BCBS Montana.
How BCBS Montana approaches CPT 22612 (Arthrodesis, Posterior — Lumbar (PLF)) for prior-authorization review: at last review on 2026-01-01, the policy covers this code with prior authorization required.
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Carelon Spine Surgery 2025-11-15 (effective 2026-01-01)Criteria summary
High-level themes from the BCBS Montana policy of record for CPT 22612. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 6 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Carelon Clinical Appropriateness Guidelines — Spine Surgery (delegated UM for HCSC/BCBS Montana)
See the full BCBS Montana criteria.
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